An estimated 530 deaths occur each year in Utah from alcohol attributable causes. There are consistent gender disparities in alcohol-attributable deaths in Utah. Men are disproportionally among the alcohol fatalities, while women account for 150 (28%) of these deaths (Centers for Disease Control [CDC], 2010). In Utah, a lower prevalence of adult women (18 and older) report binge drinking (7.5 percent) compared to the national average for women (11.1 percent) (CDC, 2019). However, alcohol-attributable harms, such as alcohol-attributable emergency department (ED) visits and in-patient hospitalizations, have increased at a higher rate for both genders in the past decade relative to national trends (Talwakar and Ahmad, 2013).
Consistent monitoring of alcohol-attributable harms may be useful in supporting the development and implementation of evidence-based prevention strategies recommended by the Community Preventive Services Task Force. These strategies to reduce excessive drinking and related harms include increasing taxes on alcohol purchases, regulating the density of alcohol outlets, and having and enforcing commercial host liability laws (The Community Guide, 2015).
Binge drinking is defined as consumption four or more drinks on a single occasion for a woman or five or more drinks for a man (National Institute of Alcohol Abuse and Alcoholism, 2004). Most people who binge drink are not alcohol dependent or alcoholics (Esser et al., 2014). However, binge drinking is the most common form of excessive alcohol use and can have both immediate and long-term effects on women’s health.
A few of the short-term effects associated with excessive drinking include injuries from motor vehicle crashes or falls, violence in the form of sexual assault or suicide, alcohol poisoning, risky sexual behaviors, and miscarriage and stillbirth among pregnant women (CDC, 2015).
Several of the long-term effects of excessive alcohol use include increased risk of high blood pressure, various cancers, learning and memory problems, mental health problems like depression and anxiety, social and family problems, and alcohol dependence (CDC, 2015).
This report describes alcohol-attributable emergency department (ED) visits and inpatient hospitalizations for women 18-64 years of age between 2004 and 2014.
Data include ED visits and hospitalizations with a primary, 100 percent alcohol-attributable diagnosis (CDC, 2010). Diagnoses that are not always attributed to alcohol use (e.g., falls and motor vehicle crashes) are not included. Therefore, calculated numbers may underestimate the true impact of alcohol use.
In 2014, 2,263 ED visits were alcohol-attributable for Utah women aged 18-64, up from 1,150 in 2004. In 2014, the rate of alcohol-attributable ED visits per 10,000 population was 26.2 compared to 16.0 in 2004, a 63.1 percent increase. In contrast, the overall rate per 10,000 population of total ED visits for women aged 18-64 decreased slightly from 3,252.3 in 2004 to 3,226.9 in 2014 (Figure 1) (Utah Emergency Department Encounter Database, 2015; Utah Inpatient Hospital Discharge Data, 2015).
Alcohol-attributable hospitalizations for women 18-64 years old increased from 444 (6.2 per 10,000 population) in 2004 to 958 (11.1 per 10,000 population) in 2014, a 78.8 percent increase. In contrast, the overall rate of hospitalizations per 10,000 for this population decreased from 1,268.5 in 2004 to 1,062.3 in 2014, a 16.3 percent decrease (Figure 1). By age group, the rate of alcohol-attributable ED visits and hospitalizations varied. Women aged 18-34 years had an 83.6 percent increase (12.4 in 2004 to 22.7 in 2014) in alcohol-attributable ED visits and a 154.4 percent (2.6 to 6.6) increase in alcohol-attributable hospitalizations. Women aged 35-49 years had a 42.5 percent increase (23.5 to 33.4) in alcohol-attributable ED visits and a 35.9 percent increase (12.0 to 16.3) in alcohol-attributable hospitalizations. Women aged 50-64 years had a 71.2 percent increase in alcohol-attributable ED visits (13.7 to 23.5) and a 111.2 percent (6.0 to 12.6) increase in alcohol-attributable hospitalizations.
The rate of alcohol-attributable ED visits and hospitalizations varied across the twelve local health districts (LHD). In 2004, ED rates per 10,000 population for women 18-64 years old ranged between 7.7 and 22.9, and increased by 8.1 percent to 148.7 percent in 2014, to a range of 13.8 to 48.1. Results from one LHD were not included in 2004 due to the data not meeting Utah Department of Health (UDOH) standards for publication.
In 2004, hospitalizations by LHD, for women aged 18-64 years, were between 2.2 and 11.4 per 10,000 population, and increased by 20.4 percent to 157.0 percent in 2014 to a range of 5.2 to 29.4. Results from four LHDs were not included in 2004 and three in 2014 due to the data not meeting UDOH standards for publication.
Nationally, from 2001–2002 to 2009–2010, the rate of alcohol-attributable ED visits for all adult women increased 38 percent (26 to 36 per 10,000 population) (Talwakar and Ahmad, 2013). Utah has lower overall rates of alcohol-attributable ED visits compared to these national statistics; however, Utah rates have increased more steeply.
The prevalence of binge drinking for Utah women aged 18-64 was 6.9 percent in 2005 and 8.8 percent in 2014 (Figure 2) (Behavioral Risk Factor Surveillance System [BRFSS], 2014). A change in BRFSS survey methodology and the confidence intervals shown suggest that this difference may not be significant.
Domains of Health
Excessive alcohol use is relevant to many of the domains of health and increases the risk of both chronic diseases and acute outcomes. Because of differences between women and men in body structure and chemistry, women who drink excessively are at increased risk for some health conditions compared to men, such as the following (CDC, 2015):
- Cirrhosis and other alcohol-attributable liver diseases
- Brain damage
- Damage to the heart muscle
Alcohol use also increases the risk of cancer of the mouth, throat, esophagus, liver, colon, and breast among women. Increased risk to reproductive health is a special concern. Excessive drinking may increase both the risk of infertility and a pregnant woman’s risk of miscarriage, stillbirth, and premature delivery. Women who drink alcohol while pregnant increase the risk of having a baby with Fetal Alcohol Spec-trum Disorders (FASD) and are more likely to have a baby die from Sudden Infant Death Syndrome (SIDS) (CDC, 2015).
Available Resources and Recommendations
While the prevalence of binge drinking may be increasing among women in Utah, further research could examine whether a change in binge drinking is associated with an increase in alcohol-attributable ED visits and hospitalizations. Collecting additional data, such as surveys or follow-up questions to survey respondents, may be useful in understanding excessive alcohol use and related harms.
In addition to assessing the prevalence of binge drinking, binge drinking intensity (i.e., the number of drinks per binge drinking episode) and frequency (i.e., the number of binge drinking occasions in the past month) are also informative data. In 2014, binge drinking intensity in Utah for all adults was 8.1 drinks per binge occasion while it was 7.6 binge drinks per occasion nationally (BRFSS, 2014). While our preliminary analyses did not show much change in binge drinking intensity and frequency for women aged 18-64 from 2005 to 2014, future studies could examine whether high-intensity and frequent binge drinking are associated with increased risk of alcohol-attributable ED visits and hospitalizations among women in Utah.
The Utah Department of Health employs an alcohol epidemiologist to conduct monitoring and surveillance of excessive alcohol use and related harms. The alcohol epidemiologist educates stakeholders about evidenced-based prevention strategies for reducing excessive alcohol use and related harms, such as those recommended by the Community Preventive Services Task Force (The Community Guide, 2015).
This article was supported by Cooperative Agreement Number NU58DP001005-01-00 from the Centers for Disease Control and Prevention. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the Centers for Disease Control and Prevention or the Depart-ment of Health and Human Services.
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Buckner A. (2019). Select Alcohol-Attributable Emergency Department Visits and Inpatient Hospitalizations for Women 18-64 Years of Age. Utah Women’s Health Review. doi: 10.26054/0K0BVF7JC2.