Transcript for CDC Telebriefing: New Vital Signs Report - Too many people die of alcohol poisoning in the US

OPERATOR: Welcome and thank you for standing by. I’d like to inform all parties that your lines have been places in listen only mode until the question and answer segment of today’s conference. At that time, if you would like to ask a question, please press star 1 on your telephone keypad. Today’s call is also being recorded. If you have any objections you may disconnect at this time. I would now like to turn the meeting over to your host, Mr. Benjamin Haynes. Sir, you may begin.

BENJAMIN HAYNES:  Thank you Calvin. Good Afternoon and thank you all for joining us for today’s briefing on alcohol poisoning deaths. We are joined today by CDC's Principal Deputy Director, Dr. Ileana Arias, who will provide opening remarks. Following those remarks, Dr. Arias, along with Dr. Bob Brewer, the study’s co-author, will take you questions. I’d now like to turn it over to Dr. Arias.

ILEANA ARIAS: Thank you all for joining us to discuss this month’s Vital Signs report. Each month, we focus on the latest data about one of the critical health issues facing our nation, and what we know can be done about it. Excessive drinking is responsible for many health and social problems in the United States. This includes heart disease, cancer, motor vehicle crashes, and violence. This month, we address alcohol poisoning deaths, a deadly consequence of binge drinking. Alcohol can be lethal. This Vital Signs finds there are 6 deaths a day on average from alcohol poisoning. The majority of these deaths are NOT among college students, but among middle-aged men. As we’ve previously reported, excessive drinking in general is responsible for 1 in 10 deaths among working-age adults (20-64 years) in the US each year, and cost the U.S. economy about $224 billion in 2006, or $1.90 per drink. Furthermore, about $2 of every $5 in costs are paid by government, so we’re all paying the cost of excessive drinking. About 90 percent of U.S. adults who drink excessively are binge drinking, and binge drinking accounts for most of the deaths and economic costs from excessive drinking. Binge drinking refers to men drinking 5 or more alcoholic drinks and women drinking 4 or more drinks, within about 2-3 hours. Despite its risks, more than 38 million U.S. adults report binge drinking about 4 times per month and consume an average of 8 drinks per binge. Alcohol poisoning is caused by consuming a very large amount of alcohol in a short period of time. A person’s response to alcohol can vary depending on many factors, including the amount and rate of alcohol consumed, the health of the drinker, and whether the drinker has consumed other drugs.  The key point is: The more you drink, the greater your risk of death. In this study, we analyzed deaths due to alcohol poisoning among people 15 years and older using death certificate data for 2010 to 2012, which were reported to the National Vital Statistics System. We found: 2,200 Americans died each year of alcohol poisoning – an average of 6 deaths every day, and this is likely to be an underestimate. Three in four alcohol poisoning deaths involved adults 35 to 64 years old. Most of the deaths also occurred among men. When assessed by race and ethnicity, the majority of deaths were among non-Hispanic whites.  However, American Indians/Alaska Natives had the most alcohol poisoning deaths per million people. Alcohol poisoning death rates also varied widely across states, from 5.3 deaths per million residents in Alabama to 46.5 deaths per million residents in Alaska. Alcohol dependence was identified as a factor in 30 percent of these deaths, and other drugs contributed to 3 percent of the deaths. Alcohol poisoning deaths can be reduced by preventing binge drinking. Scientifically-proven programs and policies for reducing binge drinking include: Regulating the number and concentration of alcohol retailers in a community; preventing illegal alcohol sales and holding alcohol retailers liable for harms resulting from illegal sales; and adopting pricing strategies that reduce excessive drinking. States and communities can develop partnerships with groups including police, community groups, health departments, colleges, and doctors, nurses, and other health care providers to implement these strategies to reduce binge drinking and related harms. Health professionals can also screen all adult patients for excessive drinking, counsel those who do to help them drink less, and refer excessive drinkers who are alcohol dependent for specialized treatment. We can also all follow the US Dietary Guidelines on alcohol. These include recommendations that: You don’t start drinking or increase the amount you drink based on potential health benefits. If you choose to drink, do so in moderation, which is defined as up to 1 drink a day for women and up to 2 drinks a day for men. Don’t drink at all if you are under age 21, if there’s a chance you could be pregnant, if you have health problems that could be made worse by drinking, or if you are engaging in activities that could be made more dangerous by drinking, such as driving a car. It is also important to recognize that a standard drink of alcohol contains the same amount of alcohol no matter what type of beverage is consumed.  A 12-ounce can of 5 percent beer has the same amount of alcohol as a 5-ounce glass of 12 percent wine or an ounce-and-a-half of 80-proof distilled spirits. It is also best to avoid drinks with unknown alcohol content and be cautious when mixing alcohol with energy drinks. Caffeine can mask alcohol’s effects, causing you to drink more than you intended. Last but not least, you should get help for anyone experiencing life-threatening signs of alcohol poisoning. The life-threatening signs of alcohol poisoning include: Inability to wake up; Vomiting; Seizures; Slow or irregular breathing or heart rate; And low body temperature, bluish skin color, or paleness. Bottom line: Alcohol poisoning deaths are a heartbreaking reminder of the dangers of drinking too much alcohol, killing 2,200 people a year. These are preventable deaths that don’t have to happen. Alcohol poisoning is killing people across the lifespan and, in particular, men in the prime of their lives. We need to implement effective programs and policies to prevent binge drinking and the many health and social harms that are related to it, including deaths from alcohol poisoning. Thank you for joining us today and helping to get the word out about binge drinking and related deaths. Now Dr. Brewer and myself are very happy to entertain your questions.

OPERATOR: Our first question comes from Mike Stobbe, with the Associated Press. Your line is open.

MIKE STOBBE: Hi, thank you for taking my question. I had two detailed questions. One was, the data is for, I think you said, people 15 and older. Would you mind just saying why that was the starting age, 15 and older, or is that just how the statistics are grouped for some reason? My second question is, you mentioned that not every alcoholic beverage has the same amount --- 12 ounce beers are roughly equivalent to 5 ounces of wine --- do you happen to have data on what type of alcoholic beverage was most commonly consumed in these deaths? Was it mostly hard liquor or what was the chosen alcoholic beverage?

ILEANA ARIAS: Sure, I’ll start with those and then have Dr. Brewer add. In terms of the age group, you are right, that that age bracket does start at age 15. However, that was not the driving force behind the choice to look at that age group. Although, alcohol is illegal for that young age group, we noticed a significant amount of excessive drinking, binge drinking, among those individuals as well. So we wanted to make sure that we were capturing the entire --- of people who are at risk. Not only for binge drinking, but then the related death associated with binge drinking. In regard to the alcohol content and what type of alcohol might have been more relevant or operative, I’ll let Dr. Brewer answer that.

BOB BREWER: Thanks for your question Mike. This is Dr. Bob Brewer. We were not able in this study to specifically look at the type of alcoholic beverage that was consumed by people who died of alcohol poisoning. However, as Dr. Arias pointed out there is a hand and glove relationship between alcohol poisoning death and binge drinking. And we know that beer is by far the beverage of choice adult binge drinkers. Liquor, however, is by far the most common beverage consumed by binge drinkers who are underage. That is under age 21. So again while we were not able to specifically look at the type of alcohol and beverage consumed by people who died of alcohol poisoning, we do know that there are some important differences in the type of beverage consumed by binge drinkers. Again, with beer being the most common for adults and liquor for underage youth.

BENJAMIN HAYNES: Okay, Calvin, next question please.

OPERATOR: Thank you. As a reminder, if you would like to ask a question, please press star 1 on your telephone keypad. Our next question comes from David Beasley with Reuters. You line is open.

DAVID BEASLEY: Yes, is this the first time this type of study has been done. In other words, with this type of data.

ILEANA ARIAS: We have a history of publishing data on excessive drinking, binge drinking across age groups and various sub populations. This time, we decided to focus on the poisoning issue, since one of the things that people do not associate with binge drinking is the lethal function it can serve. We wanted to highlight and focus on that this time around.

DAVID BEASLEY: There is no way to compare to similar study done two or three years earlier. This is pretty much a new analysis based on alcohol poisoning deaths? 

BOB BREWER: This is Dr. Brewer again. Unfortunately, we really cannot look at trends when it comes to alcohol poisoning deaths, because the procedure for classifying these deaths changed a bit over the past ten years or so. The last time though that a report like this has been done by anybody that we're aware of at least and should be by a federal agency looking at alcohol poisoning deaths across the life span was on the order of about 15 years ago. This has not been looked at certainly in the way we did in this report for some time. 

DAVID BEASLEY:  One other quick question. American Indians/Alaskan natives, they are one group for this study, but are they considered two different groups? Are they one and the same? Are these Indians that live in Alaska or are they Indians and Alaska natives? Do you see what I am saying?   

ILEANA ARIAS: We can't make that discrimination. Basically, we are using the census categorization of race and ethnicity. Basically, these are people who then are being classified in that category.   

DAVID BEASLEY: Are these all Indians and Alaskan natives. 

ILEANA ARIAS: It’s a combination and we don’t have a way of distinguishing who is who.

DAVID BEASLEY: I just noticed that they had such a high rate. I wanted to make sure exactly who we were talking about, but they are just a census classification I guess. 

BOB BREWER: This is Dr. Brewer. The American Indian/Alaska natives are grouped together. A common characteristic they share that is particularly relevant for our issue concerning alcohol poisoning deaths is that it is well-known that American Indians and Alaskan natives that binge drink tend to drink at very high levels. They have very high level binge drinking intensity. And as Dr. Arias pointed out, the more you drink, the greater your risk of death. This is a population that among those who do binge drink, among American Indians and Alaskan natives who do binge drink, they tend to drink a lot when they do and that does increase their risk of death from alcohol poisoning. 

BENJAMIN HAYNES: Next question, please. 

OPERATOR: Our next question comes from Leonard Bernstein with The Washington Post. Your line is open. 

LEONARD BERNSTEIN: You guys did a report in 2012 that said the group with the most binge drinkers with the most is 18-34 year olds and the group that binge drinks often is 65 plus. Why do the middle age folks die more often? 

BOB BREWER: I think you are right about that. Binge drinking tends to be more common in younger age groups and then the other statistic you referred to is that the frequency of binge drinking tends to be higher in the 65 plus group. What is of particular relevant of this study though is the number of drinks consumed by people who binge drink. That can be high in young people too and frankly across the life span. I think what we are seeing in this particular case is, again, evidence that binge drinking is not a problem with young people. It really is a problem across the life span. Binge drinking intensity and the number of drinks consumed seem to be higher among men, which are reflected in the fact that a large proportion of these poisoning deaths are among men. It’s a big problem with middle age adults as well.

LEONARD BERNSTEIN: So death rate is directly associated with number of drinks? 

BOB BREWER: Yes. Correct. Right. The death from alcohol poisoning, the risk of death from alcohol poisoning goes up significantly with the amount that people consume. Clearly, it is directly linked to binge drinking in general, which Dr. Arias appropriately defined as four or more drinks within a short period of time for a woman and five or more within a short period of time for a man. The reality is that most adults who binge drink are drinking well above that level, at an average of 8 drinks per binge. And that is in fact what we reported in the report you were referring to before. This is an outcome that is very directly linked to binge drinking intensity and for us really emphasizes why we have to do a better job of preventing binge drinking. Particularly ratcheting the number of drinks consumed per for binge episode and the number of times people engage in this behavior. 

OPERATOR: Our next question comes from Kim Painter with USA Today. Your line is open. 

KIM PAINTER: My remaining question was sort of a version of the one you just answered.  Let me put it a different way. Given the public perception that this is a problem for teenagers and college students, most news stories about alcohol poisoning concern those groups. I'm wondering if you were at all surprised to see that the deaths were disproportionately in a much higher age group and just 5 percent of the deaths were among people under 24. 

ILEANA ARIAS: Yes. We were surprised. Again, you know, like yourself, and others, we do have a tendency to sort of worry about young people, because of the pattern of drinking that they engage in for a number of different reasons. So we're surprised that the majority of the burden of these poisoning deaths was not in that group. We felt that although we are surprised, I think it is very important to get the word out, because people miss that. They tend to think that because they are not in the category that is at the high risk for binge drinking that they are not at danger for suffering the harms including death and fatal outcomes. 

BOB BREWER: This is Dr. Brewer. Just to pick up on Dr. Arias’ point, we were surprised about this finding, but at the same time when we stepped back and reflected a bit we know that most of the binge drinking episodes, which are over 1.5 billion in the United States per year, are among people who are 26 and older. In fact, contrary to conventional wisdom, there is a lot of binge drinking that’s going on by people who are post college age. The other thing that's very important to recognize is that there is a very strong relationship in states between binge drinking by young people and binge drinking by adults. That makes sense when you realize a lot of the factors in the environment that are driving binge drinking as Dr. Arias talked about before, things like the availability of alcohol, promotion of alcohol, price of alcohol, are factors that affect both youth and adults. There is a very strong relationship between the two. Yes, we were surprised that these deaths were as concentrated in middle age adults as they turned out to be. 

KIM PAINTER: Okay, thanks. 

OPERATOR: Our next question comes from Cameron Scott with Healthline. Your line is open. 

CAMERON SCOTT: Thank you. So you have mentioned -- two quick questions. You mentioned that there are more men than women. I wondered if you could give a percentage breakdown. I know you are also saying the number of drinks that it would take to put one's self-at risk defends on a lot of other factors. For the readers benefit, I wonder if you could give a rough range of what we are talking about? 

BOB BREWER: First of all, this is Dr. Brewer. As far as the breakout between men and women, about 3 out of 4 alcohol poisoning deaths during the time period 2010 to 2012, involved men. Conversely, 1 out of 4 involved women. Your second question then had to do with some of the other factors that influenced whether or not somebody dies of alcohol poisoning in addition to the amount that they drink. Was that your other question? 

CAMERON SCOTT: Well, no. I was saying I know that you're hedging a little bit in terms of giving a number of drinks that this would take because of those other factors. I'm wondering if you could, with that in mind, give a range of drinks that we are talking about to put someone at risk of death. 

BOB BREWER: You know, we really can't do that, because, again, the level of alcohol consumption or the blood-alcohol level that you need to have to result in poisoning deaths is so variable. So what we can tell you, though, is that there is a very direct relationship between death from alcohol poisoning and binge drinking at high intensity. Binge drinking although commonly defined as the number of drinks within a short period of time can also be defined as a level of consumption that results in a blood-alcohol level of .08, which is the legal blood alcohol for driving in all states. So once one gets above that level of consumption, the risk of death from alcohol poisoning really goes up. That's one of the reasons why we think this is such an important indicator. Alcohol poisoning deaths are such an important indicator of the work we need to do to prevent binge drinking. If we could eliminate binge drinking, we would dramatically reduce the risk of alcohol poisoning deaths.

BENJAMIN HAYNES: Calvin, we have time for one more question. 

OPERATOR: Our last question comes from Kimberly Leonard with US News & World Report. Your line is open. 

KIMBERLY LEONARD: Thank you for taking my questions. I was wondering about the laws in states that you said were helpful in preventing binge drinking. We talked about the price of alcohol and limiting the access to alcohol. Do you mean, for example, having stores that separately sell alcohol versus selling them in grocery stores or in CVS, places like that? What are some other examples of policies that have worked? 

BOB BREWER: Well, this is the good news. I'm glad you asked this question. There are a number of policies that the science has told us can really work to reduce binge drinking and harms related to it, including this particular tragic outcome like death from alcohol poisoning. To respond specifically to your question about alcohol availability, what Dr. Arias was alluding to is the concentration of retail alcohol outlets within a particular area. It is often referred to as alcohol outlet density. What we know is that if you have a higher concentration of retail alcohol within a particular community, people tend to drink more and you tend to get more problems related to alcohol in that area. Poisoning is certainly one of those. As Dr. Arias mentioned, there are a number of other problems that we are concerned about that are related to greater availability of alcohol. Regulating alcohol outlet density, setting reasonable controls on the availability is certainly one of the most effective strategies. Maintaining limits on days and hours when alcohol is sold is another important tragedy and set of policies that relate the two alcohol availability. Alcohol consumption is connected to the price of alcohol. A 10 percent increase in the price of alcohol reduces consumption by about 7 percent across different beverage types. Price and availability are two key factors. Advertising and marketing is also a very important issue, particularly for young people. We know that young people who are exposed to more alcohol advertising are more likely to start drinking and drink more as they do. Those are among the strategies that are particularly important to look at to reduce binge drinking among adults and among you. 

KIMBERLY LEONARD: Is there any evidence to show that having separate perhaps abc stores the way Virginia or Maryland has. I am calling from the D.C. area. I'm thinking about this. Is there any evidence to show that having separate alcohol stores versus selling alcohol in a grocery store, for example, has any effect on binge drinking or on the consumption of alcohol? 

BOB BREWER: I think the critical factor there is not so much whether or not alcohol is being sold with other products as much as it has to do with the number of locations where people can purchase alcohol. I think what you're perhaps getting at with your question is whether or not there is any evidence that if you have greater control over the number of locations, government  control, for example, over the number of alcohol outlets selling, let's say, liquor, as a specific example, whether or not that is associated with lower rates and excessive drinking. The answer is yes and we know that primarily from studies that have looked at what happens when you take away those controls. The scientific evidence shows that when you privatize alcohol sales in locations that previously had government control, alcohol consumption or alcohol sales goes up by an average of about 40 percent. These are based on some studies that were done looking at privatization events that happened a while ago. Whether or not we would see exactly that same increase from privatization now, I think we need to look at further. The reality is that if you make alcohol more available, which is what happens when you privatize sales, then you tend to get a substantial increase in alcohol consumption and harms related to it. 

KIMBERLY LEONARD: Thank you. 

OPERATOR: I would now like to turn the call back over to Mr. Benjamin Haynes. Sir, you may begin. 

BENJAMIN HAYNES:  Thank you, Calvin. Thank you all for joining us again today for today's briefing. A transcript will be available at cdc.gov/media. If you have additional questions, you can call 404-639-3286 or e-mail media at cdc.gov. Thank you.

OPERATOR: That concludes today's conference call. Thank you for your participation. You may disconnect at this time. 

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U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES