Longitudinal analysis of alcohol-related emergency department visits from 1993 to 2021

This nationwide, serial cross-sectional study examines long-term trends in alcohol-related emergency department (ED) visits from the National Hospital Ambulatory Medical Care Survey (1993-2021), highlighting demographic differences and distinguishing between chronic and acute conditions. The analysis included patients aged ≥15 years with ED visits classified as alcohol-related using Alcohol-Attributable Fractions (AAFs), determined with the CDC's Alcohol-Related Disease Impact method. Fully alcohol-attributable visits (AAF1, 100% attributable) and partially alcohol-attributable visits were examined. The primary outcome was trends in AAF1 ED visit rates over time, while secondary outcomes included stratifications by demographic characteristics (age, sex, race) and in AAFs by condition type (chronic vs acute). Comparing 1993-1994 to 2019-2021, 100% alcohol-attributable ED visit rates rose by 139%; from 4.4 to 10.5 per 1000 US population (P < 0.001), exceeding the 28% increase in overall ED visit rates (339-433 visits per 1000). The greatest relative increases were among adults aged ≥50 years (242%), males (146%), and among White patients (190%). Chronic AAF ED visits increased by 158%, while acute visits declined by 12%. The disproportionate growth in alcohol-related ED visits (relative to overall ED visits) underscores the need for targeted prevention and intervention strategies that address high-risk populations and mitigate impact on the healthcare system.