In a state with one of the lowest levels of binge drinking as well as one of the lowest levels of overall alcohol consumption in the U.S., why do statistics show that Utah is the seventh-worst state for alcohol poisoning deaths? The first two facts are to be expected: after all, three-fifths of the population of Utah is Mormon, and Mormons typically don’t drink. But the fact that Utah has one of the highest rates of alcohol poisoning in the nation isn’t so easy to explain. So what’s going on? Finding the answer means looking more closely at the statistics and also considering the effect of an anti-alcohol social norm and large numbers of people living in remote areas.
The findings come from a Centers for Disease Control and Prevention (CDC) Morbidity and Mortality Weekly Report, released in January, which looked at alcohol poisoning deaths in the U.S. from 2010 to 2012. The report found that the average death rate from alcohol poisoning in those aged 15 and over across the nation was 8.8 per million. For Utah, the corresponding rate was a massive 16.7 per million. Aside from the top two ranking states—New Mexico and Alaska, which had much higher rates of 32.7 and 46.5—most of the states with rates higher than Utah’s didn’t have much higher figures. Only two deaths per million separated Utah from fourth-worst Arizona.
The unadjusted rate (the average number of alcohol poisoning deaths per year) for Utah was 33 deaths per year, which doesn’t compare too favorably with many other states. Wisconsin generally doesn’t do well in alcohol statistics, but despite having twice the population of Utah, it averaged 28 alcohol poisoning deaths per year, and its age-adjusted rate of just six per million of the population aged 15 and over was the fifth-lowest in the nation.
Digging a little deeper, Anna Fondario—who works with the state’s health department—reports that 156 Utahns died of alcohol poisoning from 2009 to 2013. When the results were broken down by age, there was another surprise: only five men and fewer than five women aged 24 and younger were among the deaths in the five-year period. The most at-risk age group was men aged 45 to 64, among whom there were 64 deaths.
In the CDC statistics, too, the highest nationwide death rate was among those aged 45 to 54: as much as we may see excessive drinking as a young person’s problem, it’s actually middle-aged drinkers who die most often from poisoning.
Explaining the Utah Effect
There are a few potential explanations for the disparity between the overall drinking rate in Utah and the shockingly high number of alcohol poisoning deaths. The first of these is fairly straightforward: even if not as many people in Utah drink, maybe those who do will have more drinks per episode of drinking.
In 2010, Utah was ranked as joint-lowest in the nation for binge drinking—which is defined as four drinks for women and five drinks for men (or more) in a single episode of drinking—with just 10.9 percent of the population binge drinking. Utah was toward the upper end for the number of drinks consumed per binge (with around eight consumed per occasion), but Wisconsin was the worst on that measure, with an average of nine drinks per binge. So the “intensity of drinking” explanation isn’t particularly strong, since Wisconsin came off much better than Utah in the poisoning stats.
The CDC noted that cultural and religious beliefs could be an important factor, and with Utah’s large Mormon population, it seems plausible. One possibility is that the dominant religious culture produces a counterculture, and for those associating with that counterculture, drinking could be a way to cement and display their non-conformist nature. On a related note, Mormons who do drink may be less likely to get the help they need for fear of social consequences. In Wisconsin, friends will be there to help if there is a possible alcohol poisoning, but for Mormons who drink secretively, such help may not be available.
While the latter argument may hold some weight, the countercultural drinking hypothesis seems to fall flat in older adults, who made up most of the poisoning deaths but are unlikely to be drinking to cement their identities. Instead, they may be more likely to have been heavy drinkers for a while. However, the CDC statistics show that less than a third of those who died were classed as dependent on alcohol, so addiction alone doesn’t explain these older adults’ drinking habits either.
Finally, the fact that many drinkers could live in remote locations—where it’s harder to get emergency medical support—could have a role to play in the Utah effect. Looking at the death rates by region does lend weight to this hypothesis, with the sparsely-populated southeast having higher poisoning rates and the central portion of the state having twice the rate of poisonings of the metropolitan Wasatch Front region.
Bringing Alcohol Poisoning Rates Down
The CDC recommends reducing the density of bars, restaurants, liquor stores and any alcohol-selling establishments within the most affected areas to bring poisoning rates down, and improving screening and interventions for alcoholism and binge drinking. However, it’s clear from the case of Utah that the problem is a complex one: if even a state with generally low rates of drinking can have high poisoning rates, it shows that general approaches may be too simplistic. From the case of Utah, it seems that ensuring adequate access to emergency healthcare and encouraging open discussions of drinking—even in traditionally prohibitionist cultures—may be a big part of the solution, alongside helping more of those struggling with addiction get into treatment.