Hospitalization of underage drinkers in the United States is common and costly

A new study of the prevalence of underage drinking highlights one of its significant consequences: hospitalization. Of the 40,000 youth ages 15 to 20 years who were hospitalized in 2008 and diagnosed with alcohol use disorder (AUD), 79 percent were intoxicated when they arrived at the hospital.

"Hospitalization for Underage Drinkers in the United States" was published in the June 2012 issue of the Journal of Adolescent Health. Terry D. Schneekloth, M.D., with the Department of Psychiatry and Psychology at Mayo Clinic in Rochester, Minn., and an author of the study says, "Our primary aim was an assessment of the scope of a significant consequence of underage drinking — hospitalization. We examined discharge records to determine the youth who were discharged with an alcohol use disorder (AUD) diagnosis. The AUD diagnoses included alcohol intoxication, alcohol dependence syndrome, nondependent abuse of alcohol and alcohol-induced mental disorders."

To determine the pervasiveness of the problem, Dr. Schneekloth and a team of researchers at Mayo Clinic in Rochester, Minn., used the National Inpatient Sample (NIS), a database of hospital and inpatient stays, to evaluate:

• Characteristics of youth hospitalized for alcohol use
• Incidence of hospitalizations
• Hospitalization outcomes

"The hypothesis was that hospitalization of underage drinkers is a significant issue," says Dr. Schneekloth. "We learned that the problem is both common and costly — estimated at $755 million in the year studied."

Using the NIS 2008 database, the most recent data available, the research team identified discharge records of individuals between 15 and 20 years of age who received a diagnosis of AUD. Hospitalization incidence rates were calculated on the basis of population estimates from the U.S. Census Bureau. Characteristics of the hospitalizations included:

• Of 699,506 nonobstetric discharges of 15- to 20-year-olds, 39,619 (5.6 percent) had an AUD diagnosis with or without an injury diagnosis.
• Only 25 percent were admitted following altercations and injuries, but they accounted for $505 million of the $755 million cost.
• A total of 107 of these hospitalized youth died (0.27 percent). Their average age was 18.6 years, 82 percent were male, and 73 percent of the deaths occurred during a hospitalization for injuries.
• The overall annual incidence of AUD hospitalization was 18.3 per 10,000 boys and 12.3 per 10,000 girls.
• The average age of the youth with alcohol-related discharges was 18 years; 61 percent were male.
• For adolescent boys and girls, the incidence of AUD-related hospitalization was highest in the Midwest (36.8 percent) and lowest in the West (17.7 percent). The incidence in the South was 20.9 percent.
• In general, blacks had lower hospitalization rates than whites, and Hispanics and Asian/Pacific Islanders had the lowest rates.
• The rates tended to be highest for Native Americans and other or mixed-race adolescents; however, the number of hospitalizations was relatively small, making estimates imprecise.

Underage drinking trends

Up to 71 percent of high school students report having consumed alcohol at least once, although the prevalence of heavy drinking (more than five drinks in a row within the preceding two weeks) is lower (up to 23 percent). "When teenagers drink, they tend to drink excessively, putting them at risk of significant harmful consequences," says Dr. Schneekloth.

Assessment at Mayo Clinic

In 2009, Mayo Clinic implemented an assessment plan for any hospitalized patient with an identified alcohol use problem. A social worker trained in substance abuse assessment provides the evaluation and refers the patient for further professional assessment and treatment when indicated.

Harmful alcohol use in adolescence is also a harbinger of alcohol abuse in adulthood. "We hope these findings may help target substance abuse prevention efforts toward geographic and demographic groups at greatest risk," says Dr. Schneekloth.

Points to remember

• Hospitalization of underage drinkers is common, especially in certain races and in certain geographic regions, and is associated with a substantial health care expenditure.
• When teenagers drink, they tend to drink excessively, putting them at risk of significant harmful consequences.
• Harmful alcohol use in adolescence is also a harbinger of alcohol abuse in adulthood.