Dependence
Gender Male 52.5%
Female 39.5%
Race White 49.9%
Black 38.4%
Other 49.6%
Age Group Under 18 29.2%
18-24 41.2%
25-34 41.8%
35-44 54.2%
45-54 64.2%
55 and over 73.6%
Total 48.1%
Alcohol-Related Morbidity and Mortality
Hospital discharge records show that in 2006, 877 inpatient treatments for alcohol psychoses and alcohol dependence occurred in Indiana hospitals.
This represents one-half percent (0.5%) of all hospital discharges (Indiana State Department of Health, n.d.).
An additional 3,385 statewide outpatient visits were recorded for these alcohol-related diagnoses (Data Analysis Team, Public Health System Development and Data Commission, 2008).
The list of ICD-104 codes for alcohol-induced causes of death was expanded in 2003 to be more comprehensive. Causes of death attributable to alcohol include alcohol-induced pseudo-Cushing’s syndrome;
mental and behavioral disorders due to alcohol use;
degeneration of the nervous system due to alcohol;
alcoholic polyneuropathy; alcoholic myopathy; alcoholic cardiomyopathy; alcoholic gastritis; alcoholic liver disease; alcohol-induced chronic pancreatitis; fi nding of alcohol in blood; accidental poisoning by and exposure
4ICD-10 = international classifi cation of diseases and related health problems, 10th revision. These codes are used to classify underlying causes of death in the United States. More information on the codes can be found at the World Health Organization (WHO) Web site at http://www.who.int/classifi cations/apps/icd/icd10online/.
2000 2001 2002 2003 2004 2005 2006 Indiana 5.7 5.1 5.3 5.3 5.2 5.1 4.9
U.S. 7.0 7.0 6.9 7.0 7.0 7.0 6.9
0.0 1.0 2.0 3.0 4.0 5.0 6.0 7.0 8.0
Rate per 100,000 Population
to alcohol; intentional self-poisoning by and exposure to alcohol; and poisoning by and exposure to alcohol with undetermined intent. Excluded are accidents, homicides, and other causes indirectly related to alcohol use, and newborn deaths associated with maternal alcohol use (Epidemiology Resource Center, Data Analysis Team, 2008).5
From 2000 to 2006, a total of 2,284 Hoosiers died from alcohol-induced causes. The age-adjusted mortality
rate for alcohol-attributable deaths has remained stable throughout this time period in Indiana and the United States. Indiana’s age-adjusted rate was 5.0 per 100,000 (95% CI: 4.46–5.54) in 2006, which was signifi cantly lower than the U.S. rate of 6.9 per 100,000 population (95% CI: 6.8–7.0) (see Figure 3.9) (Centers for Disease Control and Prevention, n.d.). (For alcohol-attributable deaths by county, see Map 3.2, page 50.)
5Alcohol-induced causes of death include the following ICD-10 codes: E24.4, F10, G31.2, G62.1, G72.1, I42.6, K29.2, K70, K86.0, R78.0, X45, X65, Y15.
Figure 3.9 Age-Adjusted Alcohol-attributable Mortality Rates per 100,000 Population in Indiana and the United States (CDC Wonder, 2000–2006)
Source: Centers for Disease Control and Prevention, n.d.
2000 2001 2002 2003 2004 2005 2006 Suicide Indiana 11.3 11.7 12.1 11.9 11.3 11.8 13.0 Suicide U.S. 10.4 10.7 10.9 10.7 10.9 10.9 10.9 Homicide Indiana 5.9 7.1 6.2 5.6 5.3 5.8 5.9 Homicide U.S. 5.8 6.0 6.0 6.0 5.8 6.0 6.1
0.0 2.0 4.0 6.0 8.0 10.0 12.0 14.0
Rate per 100,000 Population
Though alcohol use is not associated with every suicide and homicide, these violent acts often involve individuals who have been drinking. According to the Alcohol-Related Disease Impact (ARDI) database, the direct alcohol-attributable fraction for suicides and homicides in Indiana and in the nation is 23% and 47%, respectively. In other words, 23% of suicides and 47%
of homicides can be attributed to alcohol consumption (Centers for Disease Control and Prevention, 2004). (For a list of diseases that are heavily impacted by alcohol and their alcohol-attributable fraction, see Appendix 3C, page 44.) For this reason, intentional self-harm (suicide)6 and assault (homicide)7 rates may provide additional information on alcohol’s impact in a community.
From 2000 through 2006, a total of 5,146 Hoosiers committed suicide. Applying ARDI’s alcohol-attributable fraction of 23%, this means that almost 1,184 suicide deaths were attributable to alcohol. Indiana’s age-adjusted mortality rate for suicide was 13.0 per 100,000 population (95% CI: 12.1–13.9) in 2006, which was signifi cantly higher than the U.S. rate of 10.9 per 100,000 population (95%
CI: 10.8–11.0) (see Figure 3.10). Additionally, rates were signifi cantly higher for males (21.9 per 100,000 population;
95% CI: 20.2–23.6) than for females (4.7 per 100,000 population; 95% CI: 4.0–5.5). Rates were also signifi cantly higher for whites (13.8 per 100,000 population; 95% CI:
12.8–14.8) than for blacks (6.0 per 100,000 population;
95% CI: 4.0–8.1), in Indiana.
From 2000 through 2006, a total of 2,600 homicides were committed in Indiana. Applying ARDI’s alcohol- attributable fraction of 47%, this means that 1,222 homicide deaths were attributable to alcohol. Indiana’s age-adjusted homicide death rate was 5.9 per 100,000 population (95% CI: 5.3–6.5) in 2006, which was similar to the U.S. rate of 6.1 per 100,000 population (95% CI:
6.0–6.2) (see Figure 3.10). In 2006, rates were signifi cantly higher for males (8.8 per 100,000 population; 95% CI:
7.8–9.8) than for females (2.9 per 100,000 population; 95%
CI: 2.3–3.5). Rates were also signifi cantly higher for blacks (32.0 per 100,000 population; 95% CI: 27.5–36.5) than for whites (3.2 per 100,000 population; 95% CI: 2.7–3.7), in Indiana (Centers for Disease Control and Prevention, n.d.).
6Intentional self-harm (suicide) includes ICD-10 codes X60-X84.
7Assault (homicide) includes ICD-10 codes X85-Y09.
Figure 3.10 Age-Adjusted Mortality Rates per 100,000 Population for Intentional Self-Harm (Suicide) and Assault (Homicide), Indiana and the United States (CDC Wonder, 2000–2006)
Note: ICD-10 codes for intentional self-harm (suicide) include X60–X84; ICD-10 codes for assault (homicide) include X85–Y09.
Source: Centers for Disease Control and Prevention, n.d.
Alcohol consumption during pregnancy is another major concern since fetal alcohol spectrum disorders (FASD) are a direct result of prenatal exposure to alcohol. FASD is not a clinical diagnosis, but an umbrella term used to describe a range of disorders such as fetal alcohol syndrome, alcohol-related neurodevelopmental disorder, and alcohol-related birth defects. Possible physical effects include brain damage; facial anomalies;
growth defi ciencies; defects of heart, kidney, and liver;
vision and hearing problems; skeletal defects; and dental abnormalities. In the United States, the prevalence of fetal alcohol spectrum disorders is 10.0 per 1,000 live births (Substance Abuse and Mental Health Services Administration, Fetal Alcohol Spectrum Disorders Center for Excellence, 2007).
In Indiana, 396 mothers reported that they used alcohol during their pregnancy in 2006 (Indiana State Department of Health, n.d.-a). The Indiana Birth Defects and Problems Registry collects information on birth
defects and birth problems for all children in Indiana from birth to 3 years old (5 years old for autism and fetal alcohol syndrome). State law requires doctors, hospitals, and other healthcare providers to submit a report to the registry at the Indiana State Department of Health when a child is born with a birth defect. The number of children born with fetal alcohol syndrome8 dropped from 26 in 2003 to 14 in 2006 (Indiana State Department of Health, n.d.-b).