Alcohol-linked ER visits rapidly rising, though drinking per capita is down

Most Americans drink safely and in moderation. But a steady annual increase in trips made to emergency rooms as a result of drinking alcohol added up to 61 percent more visits in 2014 compared with 2006, according to a study published this month in the journal Alcoholism: Clinical and Experimental Research.

Visits to hospital emergency rooms for alcohol-related issues rose rapidly over a nine-year period, though it's unclear why.

The increase is alarming but also a bit mysterious to neuroscientist Aaron White, one of the study's authors, in part because the same nine-year period showed a mere 2 percent increase in per capita alcohol consumption overall, and an 8 percent increase in the number of emergency room visits for any reason.

White and his four co-authors, three of whom work with him at the National Institute on Alcohol Abuse and Alcoholism, have yet to understand what's behind the dramatic increase in alcohol-related ER visits.

"The lowest hanging fruit in terms of hypotheses is that there must be an increase in risky drinking in some people," White says. "Even though that is not showing up in increases in overall per capita consumption, it's enough to drive the increase in alcohol-related emergency department visits." But there is no strong evidence for a national increase in binge drinking, he adds.

The new finding comes from an analysis of a nationally representative data set that includes information on about 30 million visits to U.S. hospital-based emergency departments annually, from 945 hospitals in 33 states and Washington, D.C.

White also was puzzled by a higher rate of increase in alcohol-related ER visits year to year among women, who are catching up with men nationally in overall drinking as well as in binge drinking, drunk driving and deaths from cirrhosis of the liver caused by alcoholism. The gender gap in ER visits grew larger when the researchers looked just at visits related to chronic use of alcohol, which means drinking that causes pancreatitis, cirrhosis, withdrawal, and other ongoing health problems.

It is clear though that alcohol use is responsible for a growing proportion of all visits to emergency rooms, which is concerning in part because it's an expensive way to deal with over-drinking. Excess drinking costs an estimated $249 billion a year, according to a 2010 study. The human costs are significant too. Nearly 88,129 deaths annually were caused by excess drinking in the U.S. between 2006 and 2010, according to the Centers for Disease Control and Prevention. White and his colleagues estimate that this represents nearly 10 percent of all deaths among working-age adults. And alcohol is a carcinogen that increases the risk of several types of cancer. A separate study in mice, published last week in the journal Nature, clarified the underlying biology — a byproduct of a single dose of ethanol damages DNA in immature blood cells if that toxin accumulates. Unrepaired, this damage eventually can cause cancer.

Most people forget that alcohol is a drug that can lead to medical emergencies by itself or provoke other conditions, he says. Even people who drink in moderation should talk about their alcohol use with physicians and other health care workers to avoid any dangerous interactions with medications.

For drinkers who end up in ERs, including repeat customers, brief, non-judgmental conversations about the path they're on can lead them to cut back on drinking or drunk driving, or reduce alcohol-related injuries, at least for a few months, according to a 2016 review of past studies. Ideally though, screenings and other coordinated public health measures would prevent drinking that ended in a hospital visit. The rise in emergency room visits due to alcohol is unsurprising in at least one sense, White says. More than two-thirds of Americans over the age of 17 (more than 170 million people) drank alcohol at least once in 2014, according to statistics from the Center for Behavioral Health Statistics and Quality. In that light, the raw number of ER visits due to alcohol — just under 5 million in 2014 — is a drop in the bucket. Robin Lloyd is a freelance writer, editor and educator, as well as a contributing editor for Scientific American and an adjunct professor at New York University's Science, Health and Environmental Reporting Program. A version of this article originally appeared at Undark, a digital science magazine published by the Knight Science Journalism Fellowship Program at MIT. Copyright 2019 NPR. To see more, visit https://www.npr.org.

Correction (2018-01-11 05:00:00 UTC):

A previous title and caption incorrectly said that alcohol consumption rates are declining in the U.S. They are actually increasing.