All other clinicians completing this activity will be issued a certificate of participation. To participate in this journal CME activity: (1) review the learning objectives and author disclosures; (2) study the education content; (3) take the post-test with a 75% minimum passing score and complete the evaluation at www.medscape.org/journal/pcd; (4) view/print certificate.

This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education through the joint providership of Medscape, LLC and Preventing Chronic Disease . Medscape, LLC is accredited by the ACCME to provide continuing medical education for physicians.

PEER REVIEWED

Abstract

Introduction

Excessive alcohol consumption is a leading cause of premature mortality in the United States. The objectives of this study were to update national estimates of alcohol-attributable deaths (AAD) and years of potential life lost (YPLL) in the United States, calculate age-adjusted rates of AAD and YPLL in states, assess the contribution of AAD and YPLL to total deaths and YPLL among working-age adults, and estimate the number of deaths and YPLL among those younger than 21 years.

Methods

We used the Centers for Disease Control and Prevention’s Alcohol-Related Disease Impact application for 2006–2010 to estimate total AAD and YPLL across 54 conditions for the United States, by sex and age. AAD and YPLL rates and the proportion of total deaths that were attributable to excessive alcohol consumption among working-age adults (20-64 y) were calculated for the United States and for individual states.

Results

From 2006 through 2010, an annual average of 87,798 (27.9/100,000 population) AAD and 2.5 million (831.6/100,000) YPLL occurred in the United States. Age-adjusted state AAD rates ranged from 51.2/100,000 in New Mexico to 19.1/100,000 in New Jersey. Among working-age adults, 9.8% of all deaths in the United States during this period were attributable to excessive drinking, and 69% of all AAD involved working-age adults.

Conclusions

Excessive drinking accounted for 1 in 10 deaths among working-age adults in the United States. AAD rates vary across states, but excessive drinking remains a leading cause of premature mortality nationwide. Strategies recommended by the Community Preventive Services Task Force can help reduce excessive drinking and harms related to it.

Top of Page

Introduction

Excessive alcohol use is the fourth leading preventable cause of death in the United States (1) and costs $223.5 billion, or about $1.90 per drink, in 2006 (2). Excessive alcohol consumption includes binge drinking (ie, ≥5 drinks on an occasion for men; ≥4 drinks on an occasion for women), heavy weekly alcohol consumption (ie, ≥15 drinks/week for men; ≥8 drinks/week for women), and any drinking by pregnant women or those younger than 21 years (2). Binge drinking, the most common form of excessive alcohol consumption, usually results in acute intoxication and is responsible for over half of deaths and three-quarters of the economic costs of excessive drinking. Excessive drinking is also responsible for many other health and social problems (3,4).

In 2004, the Centers for Disease Control and Prevention (CDC) released an online version of the Alcohol-Related Disease Impact (ARDI) application to allow state public health agencies and other users to assess deaths and years of potential life lost (YPLL) attributable to excessive drinking. By using ARDI, CDC estimated approximately 75,000 deaths and 2.3 million YPLL were due to excessive drinking in the United States in 2001 (5). However, since that time, no comprehensive analysis has been conducted of US deaths and YPLL from excessive alcohol consumption. Furthermore, the ARDI application does not provide rates for death and YPLL from excessive drinking. The assessment of these rates is important because the total number of alcohol-attributable deaths (AAD) and YPLL are known to vary substantially across states (6), as does the prevalence and intensity of binge drinking (3). Finally, the contribution of excessive drinking to deaths among working-age adults (20–64 y) and those younger than 21 years is not well understood, even though excessive drinking is known to be a major cause of premature mortality, resulting in an average of 30 years of life lost per AAD (5).

The objectives of this study were to update previous national estimates of AAD and YPLL in the United States, calculate age-adjusted rates of AAD and YPLL in states, assess the contribution of AAD and YPLL to total deaths and YPLL among working-age adults, and estimate the number of deaths and YPLL that specifically involved those younger than 21 years.

Top of Page

Methods

We estimated average annual deaths and YPLL from 2006 through 2010 that were attributable to excessive drinking by using the CDC’s ARDI online application (6). The methods used in ARDI were developed by a scientific workgroup that comprised experts in alcohol and public health. The details of these methods have been discussed elsewhere (5). Briefly, ARDI estimates AAD by multiplying the number of age- and sex-specific deaths from 54 alcohol-related causes, identified by the underlying cause of death reported on death certificates, by the alcohol-attributable fractions (AAF) for that cause of death.

The majority of AAF for chronic conditions are calculated by ARDI on the basis of relative risk estimates from meta-analyses and the prevalence of alcohol use at specified risk levels (7,8). Self-reported alcohol use from the Behavioral Risk Factor Surveillance System (BRFSS) (9) was used to capture drinking at levels specified by the meta-analyses, which use slightly higher cut-points for risky drinking than those more commonly used in the United States. For the majority of acute conditions (ie, injuries), ARDI includes a direct estimate of the AAF. AAF for these conditions is based on studies assessing the proportion of deaths from a particular condition that occurred at or above a blood alcohol level of 0.10 g/dL (10). In addition, certain conditions (eg, alcoholic cirrhosis of the liver) are by definition 100% alcohol-attributable and therefore did not need to be estimated. To calculate YPLL attributable to excessive alcohol consumption, the age- and sex-specific AAD estimates for each cause were multiplied by the corresponding estimate of life expectancy based on the age and sex of the decedent.

For causes of death that were considered chronic (eg, cancer, liver disease, cardiovascular disease), AAD and YPLL were estimated for decedents aged 20 years or older; for the majority of acute conditions, they were estimated for decedents aged 15 years or older. However, ARDI also estimates AAD and YPLL for chronic conditions for persons younger than 20 years who died from conditions attributable to drinking during pregnancy (eg, fetal alcohol spectrum disorders) and for acute conditions for persons younger than 15 years who died from motor-vehicle traffic crashes or child maltreatment. ARDI provides reports of AAD and YPLL by sex, age group, and state, and for those under age 21 years.

AAD and YPLL due to excessive alcohol use, including those among decedents under age 21 years, were obtained directly from the ARDI application. Average annual national and state rates for AAD and YPLL per 100,000 population from 2006 through 2010 were calculated by dividing the average annual AAD and YPLL estimates from ARDI for 2006 through 2010 by the average annual population estimates from the US Census for 2006–2010, and then multiplying by 100,000. The rates were then age-adjusted to the 2000 US population (11).

The proportion of total average annual deaths and YPLL among working-age adults that were alcohol-attributable was calculated by dividing the average annual AAD and YPLL estimates for adults aged 20 to 64 years from 2006 through 2010 from ARDI by the total average annual deaths and YPLL for all causes for adults aged 20 to 64 years from vital statistics, and then multiplying by 100.

Top of Page

Results

An average of 87,798 AAD and 2,560,290 YPLL occurred in the United States annually from 2006 through 2010 (Table 1). Overall, 44% of the AAD and 33% of the YPLL were due to chronic conditions, and 56% of the AAD and 67% of the YPLL were caused by acute conditions. Most AAD (71%) and YPLL (72%) involved males. The most common cause of chronic AAD was alcoholic liver disease, while the most common cause of acute AAD was motor-vehicle traffic crashes.

A total annual average of 4,358 AAD (5%) and 249,727 YPLL (10%) involved those under age 21 years from 2006 through 2010 (data not shown). Similar to the findings for adults, about 78% of the AAD and 76% of the YPLL in those younger than 21 involved males. However, in contrast to the findings for adults, all of the top 3 causes of death for those under age 21 years —specifically, motor-vehicle traffic crashes, homicide, and suicide —were acute conditions. In fact, motor-vehicle traffic crashes alone accounted for 36% of the total AAD for those under age 21 years.

The average annual age-adjusted AAD rate for the United States from 2006 through 2010 was 27.9 deaths per 100,000 population, with a range of 51.2 deaths per 100,000 (New Mexico) to 19.1 deaths per 100,000 (New Jersey) (Table 2). Twenty-six states and the District of Columbia (DC) had higher average annual age-adjusted AAD rates than the national rate, and 2 states (New Mexico and Alaska) reported average annual age-adjusted AAD rates above 40 deaths per 100,000 population. The average annual age-adjusted YPLL rate for the United States from 2006 through 2010 was 831.6 per 100,000 population, with a range of 1,570 YPLL per 100,000 (New Mexico) to 570 YPLL per 100,000 (Hawaii) (Table 3). The average annual age-adjusted YPLL rates in 23 states and the District of Columbia were higher than the national rate, and 12 states and DC reported over 1,000 YPLL per 100,000 population.

Average annual AAD were responsible for an average of 9.8% of total deaths (Table 2) and an average of 11.5% of YPLL among working-age adults (20–64 y) (Table 3) from 2006 through 2010.The average proportion of total deaths among working-age adults that were alcohol-attributable ranged from 16.4% in New Mexico to 7.5% in Maryland; the average proportion of total YPLL that were alcohol-attributable ranged from 18.5% in New Mexico to 9.1% in Maryland.

From 2006 through 2010 more than two-thirds (69%) of all average annual AAD (Table 2) and 82% of average annual YPLL (Table 3) involved working-age adults (20–64 y). The proportion of average annual AAD in states that involved working-age adults ranged from 83% in Alaska to 56% in Vermont, and the proportion of average annual YPLL attributable to alcohol that involved working-age adults ranged from 88% in Alaska to 77% in Nebraska and Vermont.

Top of Page

Discussion

From 2006 through 2010, excessive alcohol consumption accounted for nearly 1 in 10 deaths and over 1 in 10 years of potential life lost among working-age adults in the United States. Furthermore, an average of 2 out of 3 AAD and 8 out of 10 alcohol-attributable YPLL involved working-age adults. Although AAD rates varied by state, the national annual average AAD rate of 27.9 deaths per 100,000 population was higher than the average annual death rate for 10 of the 15 leading causes of deaths from 2006 through 2010 (12). The majority of the average annual AAD involved males (71%); over half of AAD and two-thirds of YPLL resulted from acute causes of death, all of which were by definition attributable to binge drinking. About 5% of all average annual AAD and 10% of average annual YPLL involved those under age 21 years, most of which were due to acute conditions.

The average annual estimates of AAD and YPLL for the United States from 2006 through 2010 are similar to the 2001 estimates (5) and emphasize the substantial and ongoing public health impact of excessive drinking in the United States. The differences in age-adjusted AAD and YPLL rates in states probably reflect differences in the prevalence of excessive drinking, particularly binge drinking, which is affected by state and local laws governing the price, availability, and marketing of alcoholic beverages (13). The differences in AAD and YPLL rates in states probably also reflect other factors, including access to medical care and vehicle miles traveled, which could affect the risk of death from alcohol-related conditions (13,14). The higher rates of AAD and YPLL among men than women probably also reflects the higher prevalence, frequency, and intensity of binge drinking, the most common pattern of excessive alcohol consumption, among men (15).

The substantial contribution of excessive alcohol consumption to total deaths and premature mortality among working-age adults (20–64 y) in the United States, as well as the large proportion of these deaths (69%) and YPLL (82%) that involved working-age adults, is consistent with studies assessing the contribution of harmful alcohol consumption to the global burden of disease (16) and also reflects the substantial effect that excessive alcohol consumption has across the lifespan. The concentration of AAD and YPLL among working-age adults is also a major factor contributing to alcohol-attributable productivity losses from premature mortality, which, together with reduced earnings by excessive drinkers, was responsible for 72% of the estimated $223.5 billion in economic costs from excessive alcohol consumption in 2006 (2).

The findings in this report are subject to several limitations. First, data on alcohol consumption used to calculate indirect estimates of AAF are based on self-reports and may underestimate the true prevalence of excessive alcohol consumption because of underreporting by survey respondents and sampling noncoverage (17). A recent study that used BRFSS data found that self-reports identify only 22% to 32% of presumed alcohol consumption in states on the basis of alcohol sales (18). Second, risk estimates used in ARDI were calculated by using average daily alcohol consumption levels that begin at levels greater than those typically used to define excessive drinking in the United States. Third, deaths among former drinkers, who might have discontinued their drinking because of alcohol-related health problems, are not included in the calculation of AAF, even though some of these deaths might have been alcohol-attributable. Fourth, ARDI does not include estimates of AAD for several causes (eg, tuberculosis, pneumonia, hepatitis C) for which alcohol is believed to be an important risk factor, but for which suitable pooled risk estimates were not available. Fifth, ARDI exclusively uses the underlying cause of death from vital statistics data to identify alcohol-related causes and does not consider contributing causes of death that might be alcohol-related. Finally, age-specific estimates of AAF were only available for motor-vehicle traffic deaths, even though alcohol involvement varies by age, particularly for acute causes of death. While our results do show the substantial burden of alcohol-related consequences, many of the limitations cited could result in a substantial underestimate of the true contribution of excessive alcohol consumption to total deaths and YPLL in the United States.

This analysis illustrates the magnitude and variability of the health consequences of excessive alcohol consumption in the United States, and the substantial contribution of excessive drinking to premature mortality among working-age adults. More widespread implementation of interventions recommended by the Community Preventive Services Task Force (19), including increasing alcohol prices by raising alcohol taxes, enforcing commercial host (dram shop) liability, and regulating alcohol outlet density, could reduce excessive alcohol consumption and the health and economic costs related to it.

Top of Page

Acknowledgments

This article is dedicated to Ron Davis, MD, MA, for his visionary leadership and commitment to the prevention of excessive alcohol use. We thank Henry Wechsler, PhD, retired, Harvard School of Public Health, Harvard University. The development of the ARDI application was supported by generous grants (nos. 044149 and 059738) from the Robert Wood Johnson Foundation to the CDC Foundation.

Top of Page

Author Information

Corresponding Author: Mandy Stahre, PhD, MPH, Epidemic Intelligence Service Officer, Washington State Department of Health, Olympia, WA 98504. Telephone: 360 236-4247. Email: mandy.stahre@doh.wa.gov.

Author Affiliations: Jim Roeber, New Mexico Department of Health, Santa Fe, New Mexico; Dafna Kanny, Robert D. Brewer, Xingyou Zhang, Centers for Disease Control and Prevention, Atlanta, Georgia.

Top of Page

References

Mokdad AH, Marks JS, Stroup DF, Gerberding JL. Actual causes of death in the United States, 2000. [Published erratum in: JAMA 2005;293(3):293-4, 298]. JAMA 2004;291(10):1238–45. CrossRef PubMed Bouchery EE, Harwood H, Sacks JJ, Simon CJ, Brewer RD. Economic costs of excessive alcohol consumption in the US, 2006. [Published erratum in: Am J Prev Med 2013;44(3):198]. Am J Prev Med 2011;41(5):516–24. CrossRef PubMed Centers for Disease Control and Prevention. Vital signs: binge drinking prevalence, frequency, and intensity among adults — United States, 2010. MMWR Morb Mortal Wkly Rep 2012;61(1):14–9. PubMed National Institutes of Health. 10th Special Report to the US Congress on Alcohol and Health. Rockville (MD): US Department of Health and Human Services, National Institute on Alcohol Abuse and Alcoholism; 2000. Centers for Disease Control and Prevention. Alcohol-attributable deaths and years of potential life lost — United States, 2001. MMWR Morb Mortal Wkly Rep 2004;53(37):866–70. PubMed Centers for Disease Control and Prevention. Alcohol Related Disease Impact (ARDI) application, 2013. http://www.cdc.gov/ARDI. Accessed April 3, 2013. English DR, Holman CDJ, Milne E, Winter MG, Hulse GK, Codde JP, et al. The quantification of drug caused morbidity and mortality in Australia. 1995 edition. Canberra (AU): Commonwealth Department of Human Services and Health; 1995. Corrao G, Bargnardi V, Zambon A, Arico S. Exploring the dose-response relationship between alcohol consumption and the risk of several alcohol-related conditions: a meta-analysis. Addiction 1999;94(10):1551–73. CrossRef PubMed Centers for Disease Control and Prevention. Behavioral Risk Factor Surveillance System. http://www.cdc.gov/brfss. Accessed April 1, 2013. Smith GS, Branas CS, Miller TR. Fatal nontraffic injuries involving alcohol: a meta-analysis. Ann Emerg Med 1999;33(6):659–68. PubMed Klein RJ, Schoenborn CA. Age adjustment using the 2000 projected US population. Statistical Notes. No. 20. Hyattsville (MD): National Center for Health Statistics; 2001. Murphy SL, Xu JQ, Kochanek KD. Deaths: final data for 2010. National Vital Statistics Reports; Vol 61 no 4. Hyattsville (MD): National Center for Health Statistics; 2013. Naimi TS, Blanchette J, Nelson TF, Nguyen T, Oussayef N, Heeren TC, et al. A new scale of the US alcohol policy environment and its relationship to binge drinking. Am J Prev Med 2014;46(1):10–6. CrossRef PubMed Branas CC, MacKenzie EJ, Williams JC, Schwab CW, Teter HM, Flanigan MC, et al. Access to trauma centers in the United States. JAMA 2005;293(21):2626–33. CrossRef PubMed Kanny D, Liu Y, Brewer RD, Lu H. Binge drinking — United States, 2011. MMWR Surveill Summ 2013;62(Suppl 3):77–80. PubMed Rehm J, Mathers C, Popova S, Thavorncharoensap M, Teerawattananon Y, Patra J. Global burden of disease and injury and economic cost attributable to alcohol use and alcohol-use disorders. Lancet 2009;373(9682):2223–33. CrossRef PubMed Stockwell T, Donath S, Cooper-Stanbury M, Chikritzhs TN, Catalano P, Mateo C. Under-reporting of alcohol consumption in household surveys: a comparison of quantity-frequency, graduate-frequency and recent recall. Addiction 2004;99(8):1024–33. CrossRef PubMed Nelson DE, Naimi TS, Brewer RD, Roeber JUS. State alcohol sales compared to survey data, 1993–2006. Addiction 2010;105(9):1589–96. CrossRef PubMed Community Preventive Services Task Force. Preventing excessive alcohol consumption. In: The guide to community preventive services. New York, NY: Oxford University Press; 2005. http://www.thecommunityguide.org/alcohol/index.html. Accessed April 3, 2014.

Top of Page

Tables





Table 1. Average Annual Number of Deaths and Years of Potential Life Lost (YPLL) Attributable to the Harmful Effects of Excessive Alcohol Use, by Cause and Sex, United States, 2006–2010

Cause Deaths YPLL Male, n (%) Female, n (%) Total Male, n (%) Female, n (%) Total Chronic causes Acute pancreatitis 411(57) 313 (43) 724 8,459 (62) 5,263 (38) 13,722 Alcohol abuse 1,587 (78) 435 (22) 2,022 39,949 (76) 12,842 (24) 52,791 Alcohol cardiomyopathy 441 (86) 73 (14) 514 10,357 (84) 1,909 (16) 12,266 Alcohol dependence syndrome 2,892 (78) 836 (22) 3,728 72,208 (75) 24,099 (25) 96,307 Alcohol polyneuropathy 7 (100) 0 7 117 (100) 0 117 Alcohol-induced chronic pancreatitis 59 (72) 23 (28) 82 1,546 (70) 673 (30) 2,219 Alcoholic gastritis 23 (79) 6 (21) 29 586 (75) 191 (25) 777 Alcoholic liver disease 10,403 (72) 3,961 (28) 14,364 251,921 (69) 114,347 (31) 366,268 Alcoholic myopathy 1 (100) 0 1 23 (100) 0 23 Alcoholic psychosis 502 (77) 151 (23) 653 10,511 (76) 3,294 (24) 13,805 Breast cancer (female only) NA 391 (100) 391 NA 7,429 (100) 7,429 Cholelithiases 0 0 0 0 0 0 Chronic hepatitis 1 (100) < 1 1 20 (71) 8 (29) 28 Chronic pancreatitis 139 (55) 116 (45) 255 2,940 (56) 2,297 (44) 5,237 Degeneration of nervous system due to alcohol 104 (83) 22 (17) 126 1,804 (79) 477 (21) 2,281 Epilepsy 108 (53) 95 (47) 203 3,170 (55) 2,612 (45) 5,783 Esophageal cancer 437 (89) 55 (11) 492 6,957 (89) 848 (11) 7,805 Esophageal varices 47 (72) 18 (28) 65 1,032 (72) 397 (28) 1,430 Fetal alcohol syndrome 3 (75) 1 (25) 4 163 (68) 78 (32) 241 Fetus and newborn affected by maternal use of alcohol 1 (50) 1 (50) 2 75 (48) 80 (52) 155 Gastro-esophageal hemorrhage 19 (61) 12 (39) 31 332 (66) 173 (34) 505 Hypertension 874 (55) 729 (45) 1,603 13,684 (61) 8,737 (39) 22,421 Ischemic heart disease 516 (70) 223 (30) 738 6,745 (73) 2,434 (27) 9,178 Laryngeal cancer 198 (86) 33 (14) 231 3,126 (84) 581 (16) 3,707 Liver cancer 752 (75) 245 (25) 997 13,033 (77) 3,893 (23) 16,926 Liver cirrhosis, unspecified 4,592 (59) 3,255 (41) 7,847 93,308 (59) 64,114 (41) 157,422 Low birth weight, prematurity, intrauterine growth restriction death 106 (64) 60 (36) 165 7,915 (62) 4,790 (38) 12,705 Oropharyngeal cancer 309 (85) 56 (15) 365 5,401 (86) 912 (14) 6,313 Portal hypertension 24 (63) 14 (37) 38 511 (66) 261 (34) 772 Prostate cancer 202 (100) NA 202 1,985 (100) NA 1,985 Psoriasis <1 <1 <1 2 (67) 1 (33) 3 Spontaneous abortion NA <1 <1 NA 10 (100) 10 Stroke, hemorrhagic 1,357 (83) 286 (17) 1,643 21,292 (83) 4,389 (17) 25,681 Stroke, ischemic 329 (74) 118 (26) 447 3,812 (76) 1,227 (24) 5,039 Superventricular cardiac dysrhythymia 122 (43) 160 (57) 282 1,065 (44) 1,356 (56) 2,421 Subtotal 26,564 (69) 11,689 (31) 38,253 584,050 (68) 269,722 (32) 853,771 Acute causes Air–space transport 81 (84) 15 (16) 96 2,408 (81) 569 (19) 2,977 Alcohol poisoning 1,264 (77) 383 (23) 1,647 42,299 (75) 13,833 (25) 56,132 Aspiration 125 (57) 94 (43) 220 2,431 (59) 1,701 (41) 4,132 Child maltreatment 98 (59) 70 (42) 167 6,947 (57) 5,345 (43) 12,292 Drowning 770 (80) 193 (20) 963 27,802 (82) 6,194 (18) 33,997 Excessive blood alcohol level 0 0 0 0 0 0 Fall injuries 3,853 (51) 3,688 (49) 7,541 53,443 (58) 39,015 (42) 92,458 Fire injuries 645 (59) 444 (41) 1,089 15,914 (59) 11,014 (41) 26,928 Firearm injuries 86 (88) 12 (12) 98 3,337 (87) 481 (13) 3,817 Homicide 6,221 (80) 1,535 (20) 7,756 274,753 (81) 64,612 (19) 339,364 Hypothermia 177 (67) 88 (33) 265 4,114 (72) 1,585 (28) 5,699 Motor-vehicle nontraffic crashes 171 (78) 49 (22) 220 5,345 (77) 1,554 (23) 6,899 Motor-vehicle traffic crashes 9,764 (78) 2,696 (22) 12,460 398,376 (77) 121,314 (23) 519,690 Occupational and machine injuries 126 (94) 8 (6) 134 3,359 (94) 201 (6) 3,560 Other road vehicle crashes 146 (79) 38 (21) 184 4,857 (78) 1,363 (22) 6,220 Poisoning (not alcohol) 5,457 (65) 2,947 (35) 8,404 203,635 (65) 111,371 (35) 315,007 Suicide 6,460 (79) 1,719 (21) 8,179 210,811 (77) 62,395 (23) 273,206 Suicide by and exposure to alcohol 28 (67) 14 (33) 42 842 (62) 524 (38) 1,366 Water transport 69 (87) 10 (13) 79 2,349 (85) 427 (15) 2,776 Subtotal 35,540 (72) 14,004 (28) 49,544 1,263,023 (74) 443,497 (26) 1,706,519 Total 62,104 (71) 25,693 (29) 87,798 1,847,072 (72) 713,218 (28) 2,560,290

Table 2. Average Annual Number of Deaths and Alcohol-Attributable Deaths (AAD), and Percentage of Deaths Among All Ages and Among Persons Aged 20–64 years, by State, United States, 2006–2010.

State All Ages 20–64 years Total Deaths Total AAD Age-Adjusted AAD Rate per 100,000 Total Alcohol-Attributable Deaths, % Total Deaths Total AAD Total Alcohol-Attributable Deaths,

% United States, total 2,445,322 87,798 27.9 3.6 620,259 60,617 9.8 Alabama 47,377 1,511 31.0 3.2 13,688 1,119 8.2 Alaska 3,531 275 41.1 7.8 1,443 229 15.9 Arizona 46,023 2,362 37.2 5.1 12,178 1,626 13.4 Arkansas 28,600 920 31.0 3.2 7,874 650 8.3 California 234,436 10,572 29.1 4.5 60,612 7,476 12.3 Colorado 30,684 1,628 33.2 5.3 8,429 1,200 14.2 Connecticut 28,794 836 22.1 2.9 5,904 544 9.2 Delaware 7,477 248 26.8 3.3 1,958 172 8.8 District of Columbia 5,035 210 34.7 4.2 1,732 155 9.0 Florida 170,507 6,643 32.6 3.9 40,970 4,493 11.0 Georgia 69,347 2,555 27.6 3.7 21,580 1,854 8.6 Hawaii 9,591 304 20.8 3.2 2,355 191 8.1 Idaho 10,985 437 28.9 4.0 2,578 291 11.3 Illinois 101,218 3,042 23.4 3.0 24,479 2,067 8.4 Indiana 55,816 1,646 25.1 2.9 14,102 1,168 8.3 Iowa 27,682 775 23.8 2.8 5,322 459 8.6 Kansas 24,508 762 26.6 3.1 5,453 518 9.5 Kentucky 40,976 1,351 30.5 3.3 11,518 994 8.6 Louisiana 40,433 1,475 32.8 3.6 12,495 1,103 8.8 Maine 12,534 372 24.8 3.0 2,722 241 8.9 Maryland 43,677 1,318 22.6 3.0 11,928 899 7.5 Massachusetts 52,954 1,525 21.8 2.9 10,920 1,022 9.4 Michigan 87,136 2,945 28.1 3.4 21,977 2,020 9.2 Minnesota 37,897 1,257 23.3 3.3 7,896 778 9.9 Mississippi 28,603 1,025 34.8 3.6 8,711 755 8.7 Missouri 54,990 1,866 30.3 3.4 13,661 1,256 9.2 Montana 8,713 390 37.7 4.5 2,090 275 13.2 Nebraska 15,121 422 22.7 2.8 3,040 261 8.6 Nevada 19,147 943 34.9 4.9 5,979 694 11.6 New Hampshire 10,186 341 23.8 3.3 2,289 222 9.7 New Jersey 69,557 1,754 19.1 2.5 15,543 1,206 7.8 New Mexico 15,670 1,042 51.2 6.6 4,619 758 16.4 New York 147,610 4,011 19.6 2.7 33,826 2,659 7.9 North Carolina 76,780 2,761 28.9 3.6 20,949 1,947 9.3 North Dakota 5,832 179 26.2 3.1 1,123 115 10.2 Ohio 107,798 3,288 26.9 3.1 25,994 2,179 8.4 Oklahoma 36,120 1,350 35.9 3.7 9,974 1,000 10.0 Oregon 31,655 1,302 32.1 4.1 7,456 863 11.6 Pennsylvania 125,482 3,510 25.8 2.8 26,807 2,290 8.5 Rhode Island 9,625 292 25.3 3.0 1,948 188 9.7 South Carolina 40,107 1,534 32.6 3.8 11,995 1,133 9.4 South Dakota 7,003 249 30.0 3.6 1,431 158 11.0 Tennessee 58,120 2,064 31.8 3.6 16,891 1,511 8.9 Texas 162,469 6,514 27.9 4.0 47,458 4,660 9.8 Utah 14,171 529 22.9 3.7 3,751 393 10.5 Vermont 5,170 183 26.5 3.5 1,125 103 9.2 Virginia 58,536 1,865 23.1 3.2 15,193 1,292 8.5 Washington 47,696 1,981 29.2 4.2 11,702 1,301 11.1 West Virginia 21,195 660 33.1 3.1 5,540 468 8.4 Wisconsin 46,442 1,706 28.5 3.7 9,866 1,027 10.4 Wyoming 4,305 210 37.5 4.9 1,188 159 13.4

Table 3. Average Annual Number of Years of Potential Life Lost (YPLL), Total YPLL, and Percentage of YPLL Among All Ages and Among Persons Aged 20 to 64 Years, by State, United States, 2006–2010

State All Ages 20–64 years Total YPLL Total Alcohol-Attributable YPLL Age-Adjusted YPLL Rate per 100,000 Total Alcohol-Attributable YPLL, % Total YPLL Total Alcohol-Attributable YPLL Total Alcohol-Attributable YPLL, % United States, total 38,281,133 2,560,290 831.6 6.7 18,380,927 2,106,126 11.5 Alabama 797,361 48,424 1030.1 6.1 408,573 40,535 9.9 Alaska 75,697 9,131 1299.6 12.1 45,281 8,042 17.8 Arizona 757,615 68,826 1111.8 9.1 368,170 56,603 15.4 Arkansas 469,241 28,226 991.3 6.0 234,355 23,211 9.9 California 3,704,628 304,472 822.0 8.2 1,806,358 251,821 13.9 Colorado 506,006 47,269 942.8 9.3 254,887 40,451 15.9 Connecticut 398,287 23,149 646.4 5.8 173,316 18,988 11.0 Delaware 119,510 7,453 840.5 6.2 58,397 6,079 10.4 District of Columbia 93,741 6,725 1083.9 7.2 52,568 5,426 10.3 Florida 2,580,471 187,068 999.6 7.2 1,217,429 154,447 12.7 Georgia 1,227,003 79,183 829.1 6.5 645,519 65,864 10.2 Hawaii 145,318 7,915 569.7 5.4 68,676 6,335 9.2 Idaho 171,134 12,311 819.7 7.2 76,901 9,873 12.8 Illinois 1,557,893 91,615 711.8 5.9 723,596 73,823 10.2 Indiana 879,690 50,042 780.9 5.7 416,119 41,253 9.9 Iowa 375,846 19,885 654.8 5.3 153,969 15,498 10.1 Kansas 364,862 22,131 792.1 6.1 161,373 18,091 11.2 Kentucky 672,103 41,780 969.0 6.2 341,312 35,393 10.4 Louisiana 715,228 49,719 1116.6 7.0 379,576 41,270 10.9 Maine 176,731 9,929 723.2 5.6 77,630 8,064 10.4 Maryland 713,579 40,075 694.8 5.6 357,601 32,410 9.1 Massachusetts 728,381 41,501 616.0 5.7 318,262 34,389 10.8 Michigan 1,343,335 84,215 838.0 6.3 644,275 68,738 10.7 Minnesota 537,350 32,829 616.2 6.1 231,357 26,237 11.3 Mississippi 504,546 32,916 1134.4 6.5 261,516 27,550 10.5 Missouri 856,379 55,681 941.2 6.5 405,162 44,787 11.1 Montana 133,084 11,331 1163.5 8.5 62,408 9,471 15.2 Nebraska 214,124 11,682 651.0 5.5 88,984 9,037 10.2 Nevada 334,423 27,923 1034.9 8.3 177,069 23,441 13.2 New Hampshire 145,490 8,789 637.1 6.0 66,054 7,260 11.0 New Jersey 1,005,669 50,856 575.8 5.1 457,224 42,068 9.2 New Mexico 268,778 31,129 1570.1 11.6 142,364 26,281 18.5 New York 2,162,819 111,986 564.5 5.2 985,558 90,878 9.2 North Carolina 1,259,703 83,125 886.8 6.6 619,963 68,842 11.1 North Dakota 81,298 5,132 785.5 6.3 33,320 4,061 12.2 Ohio 1,632,999 91,851 789.8 5.6 757,943 74,828 9.9 Oklahoma 595,524 41,460 1134.1 7.0 295,639 34,833 11.8 Oregon 462,860 33,933 868.3 7.3 215,541 27,934 13.0 Pennsylvania 1,789,327 100,106 794.0 5.6 785,357 81,180 10.3 Rhode Island 131,293 7,538 687.4 5.7 56,371 6,178 11.0 South Carolina 680,320 47,267 1037.5 6.9 353,461 39,646 11.2 South Dakota 101,838 7,023 889.3 6.9 42,598 5,519 13.0 Tennessee 972,290 63,058 999.8 6.5 500,315 52,831 10.6 Texas 2,799,886 199,618 823.6 7.1 1,429,308 165,170 11.6 Utah 245,204 16,800 673.9 6.9 119,423 14,075 11.8 Vermont 72,760 4,335 664.6 6.0 32,292 3,317 10.3 Virginia 931,966 55,232 687.3 5.9 447,064 45,349 10.1 Washington 719,348 53,050 784.1 7.4 342,548 43,400 12.7 West Virginia 330,370 19,464 1056.6 5.9 162,457 16,477 10.1 Wisconsin 665,699 44,249 769.0 6.6 289,133 34,776 12.0 Wyoming 72,123 6,480 1183.3 9.0 36,352 5,563 15.3

Top of Page

Post-Test Information

To obtain credit, you should first read the journal article. After reading the article, you should be able to answer the following, related, multiple-choice questions. To complete the questions (with a minimum 75% passing score) and earn continuing medical education (CME) credit, please go to http://www.medscape.org/journal/pcd. Credit cannot be obtained for tests completed on paper, although you may use the worksheet below to keep a record of your answers. You must be a registered user on Medscape.org. If you are not registered on Medscape.org, please click on the "Register" link on the right hand side of the website to register. Only one answer is correct for each question. Once you successfully answer all post-test questions you will be able to view and/or print your certificate. For questions regarding the content of this activity, contact the accredited provider, CME@medscape.net. For technical assistance, contact CME@webmd.net. American Medical Association’s Physician’s Recognition Award (AMA PRA) credits are accepted in the US as evidence of participation in CME activities. For further information on this award, please refer to http://www.ama-assn.org/ama/pub/about-ama/awards/ama-physicians-recognition-award.page. The AMA has determined that physicians not licensed in the US who participate in this CME activity are eligible for AMA PRA Category 1 Credits™. Through agreements that the AMA has made with agencies in some countries, AMA PRA credit may be acceptable as evidence of participation in CME activities. If you are not licensed in the US, please complete the questions online, print the AMA PRA CME credit certificate and present it to your national medical association for review.

Post-Test Questions

Article Title: Contribution of Excessive Alcohol Consumption to Deaths and Years of Potential Life Lost in the United States

CME Questions

You are seeing a 30-year-old woman who reports a history of binge drinking several times per month as well as past heavy drinking. You express your concern over her drinking, but you are unsure which problem drinking pattern is most harmful. Overall, which of the following forms of problem drinking account for the highest proportion of deaths from excessive alcohol use? Heavy weekly alcohol consumption Cumulative heavy drinking during a period of at least 5 years Binge drinking Drinking during pregnancy What should you consider regarding the epidemiology of alcohol-attributable deaths and years of potential life lost in the current study by Stahre and colleagues? The gross numbers of alcohol-attributable deaths and years of potential life lost failed to decrease since the last measurement in 2001 Approximately 30% of alcohol-attributable deaths occurred among individuals younger than 21 years Alcohol-attributable deaths and years of potential life lost affected men and women equally Older adults (>65 years) accounted for most cases of alcohol-attributable deaths and years of potential life lost Which of the following states had the highest rates of alcohol-attributable deaths and years of potential life lost in the current study by Stahre and colleagues? Delaware New York New Mexico Alabama According to the current study by Stahre and colleagues, what percentage of all deaths was caused by excessive alcohol use between 2006 and 2010? 0.4% 2% 3% 10%

Evaluation

1. The activity supported the learning objectives. Strongly Disagree Strongly Agree 1 2 3 4 5 2. The material was organized clearly for learning to occur. Strongly Disagree Strongly Agree 1 2 3 4 5 3. The content learned from this activity will impact my practice. Strongly Disagree Strongly Agree 1 2 3 4 5 4. The activity was presented objectively and free of commercial bias. Strongly Disagree Strongly Agree 1 2 3 4 5

Top of Page



The opinions expressed by authors contributing to this journal do not necessarily reflect the opinions of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors' affiliated institutions.

