Public Release: 

Heavy drinking and binge drinking rise sharply in US counties

As rates of any drinking remained largely unchanged, binge drinking and heavy drinking have increased at the county level, influenced mainly by higher rates of drinking among women

Institute for Health Metrics and Evaluation

SEATTLE - Today, Americans are more likely to be heavy drinkers and binge drinkers than in recent years due in large part to rising rates of drinking among women, according to a new analysis of county-level drinking patterns in the United States.

By contrast, the percentage of people who drink any alcohol has remained relatively unchanged over time, according to the latest research by the Institute for Health Metrics and Evaluation (IHME) at the University of Washington.

Published in the American Journal of Public Health on April 23, the study "Drinking patterns in US counties from 2002 to 2012" is the first to track trends in alcohol use at the county level. Its findings focus on Americans aged 21 and older. The study was presented at the Association of Health Care Journalists conference.

Heavy drinking among Americans has increased sharply, up 17.2% since 2005. The Centers for Disease Control and Prevention (CDC) defines heavy drinking as exceeding an average of one drink per day for women and two drinks per day for men over the past month.

In 2012, 8.2% of all Americans were considered heavy drinkers and 18.3% were binge drinkers. Madison County, Idaho, had the lowest levels of binge drinking in 2012 (5.9%), while Menominee, Wisconsin, had the highest rates of binge drinking (36% among residents). For heavy drinking, Hancock County, Tennessee, had the fewest heavy drinkers (2.4% of its population) and Esmeralda County, Nevada, recorded the largest proportion of heavy drinkers (22.4%).

Nationally, 18.3% of people were binge drinkers in 2012, which the CDC defines as consuming four drinks or more for women and five drinks or more for men on a single occasion at least once during the past month. Since 2005, binge drinking has increased 8.9% across the US.

Nationwide, women showed a much faster escalation in binge drinking than men, with rates rising 17.5% between 2005 and 2012; men, on the other hand, saw rates of binge drinking increase 4.9%.

"We are seeing some very alarming trends in alcohol overconsumption, especially among women," said Dr. Ali Mokdad, a lead author of the study and professor at IHME. "We also can't ignore the fact that in many US counties a quarter of the people, or more, are binge drinkers."

These rising rates of heavy and binge drinking starkly contrast with America's trends for drinking any alcohol, which have remained largely unchanged over time (56% of people in the US consumed any alcohol in 2005 and 2012).

Some regional drinking patterns emerged at the national level, with several areas in the West, Midwest, and New England showing higher levels of alcohol consumption, particularly in comparison with a number of counties in the southern United States and Utah. But beyond regional comparisons, the most striking disparities in alcohol use were found within state lines.

In Texas, for example, rates of overall binge drinking ranged from 10.8% in Collingsworth County, well below the national average of 18.3%, to 35.5% in Loving County, nearly twice the national average in 2012. These county-level findings, which can be explored with IHME's US Health Map data visualization tool, highlight the need for more locally-focused alcohol policies and programs.

"In the US, state-level results often mask the full range of what people are experiencing health-wise," said IHME's Director Dr. Christopher Murray. "When you can map out what's happening county by county, over time, and for men and women separately, that's also when you can really pinpoint specific health needs and challenges - and then tailor health policies and programs accordingly."

Binge drinking is commonly associated with a higher risk for serious bodily harm, such as injuries, alcohol poisoning and acute organ damage. Heavy drinking is considered a risk factor for longer-term conditions, such as liver cirrhosis and cardiovascular disease.

Counties with highest rates of binge drinking, both sexes

Rank StateCounty2012 Both Sexes
1 Wisconsin Menominee County 36.0%
2 Texas Loving County 35.5%
3 Nebraska Nance County 35.2%
4 North Dakota Renville County 34.2%
5 Nevada Esmeralda County 33.8%
6 North Dakota Steele County 33.6%
7 North Dakota Nelson County 33.5%
8 Michigan Ontonagon County 33.3%
9 Montana Toole County 33.2%
10 North Dakota Burke County 33.0%

Counties with highest rates of heavy drinking, both sexes

Rank StateCounty2012 Both Sexes
1 Nevada Esmeralda County 22.4%
2 North Dakota Sioux County 21.4
3 North Dakota Rolette County 19.6%
4 Michigan Ontonagon County 19.3%
5 Montana Petroleum County 19.0%
6 Colorado San Miguel County 18.9%
7 Nevada Storey County 18.6%
8 Colorado Summit County 18.6%
9 South Dakota Buffalo County 18.3%
10 Colorado Hinsdale County 18.2%

Counties with highest rates of any drinking, both sexes

Rank StateCounty2012 Both Sexes
1 Virginia Falls Church City 78.7%
2 Colorado Summit County 78.6%
3 Colorado Pitkin County 78.0%
4 Colorado Routt County 76.7%
5 Colorado San Miguel County 76.4%
6 Colorado Ouray County 74.9%
7 Wyoming Teton County 74.9%
8 Colorado Hinsdale County 74.3%
9 Wisconsin Ozaukee County 73.3%
10 Wisconsin Portage County 73.3%

Counties with lowest rates of binge drinking, both sexes

Rank StateCounty2012 Both Sexes
1 Idaho Madison County 5.9%
2 Utah Utah County 6.5%
3 Tennessee Hancock County 7.1%
4 Utah Cache County 7.6%
5 Tennessee Johnson County 7.8%
6 Utah Rich County 8.0%
7 Idaho Franklin County 8.0%
8 Idaho Bear Lake County 8.1%
9 Tennessee Grainger County 8.2%
10 Utah Sevier County 8.4%

Counties with lowest rates of heavy drinking, both sexes

Rank StateCounty2012 Both Sexes
1 Tennessee Hancock County 2.4%
2 Idaho Madison County 2.7%
3 Texas Collingsworth County 2.8%
4 Colorado Kiowa County 3.1%
5 Utah Utah County 3.1%
6 Tennessee Grainger County 3.2%
7 Oklahoma Grant County 3.2%
8 Kentucky Bell County 3.3%
9 Oklahoma Dewey County 3.4%
10 Tennessee Johnson County 3.4%

Counties with lowest rates of any drinking, both sexes

Rank StateCounty2012 Both Sexes
1 Idaho Madison County 11.0%
2 Utah Utah County 14.3%
3 Idaho Franklin County 16.6%
4 Utah Rich County 17.9%
5 Idaho Bear Lake County 17.9%
6 West Virginia McDowell County 18.6%
7 Utah Cache County 18.6%
8 Tennessee Hancock County 18.7%
9 Idaho Oneida County 19.3%
10 Utah Juab County 19.4%

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Download the study at: http://ajph.aphapublications.org/doi/abs/10.2105/AJPH.2014.302313.

Download data for counties in each state and the District of Columbia at: http://www.healthdata.org/us-health/data-download.

Explore US trends in alcohol use and other health indicators using the US Health Map data visualization tool: http://vizhub.healthdata.org/us-health-map/.

The Institute for Health Metrics and Evaluation (IHME) is an independent global health research organization at the University of Washington that provides rigorous and comparable measurement of the world's most important health problems and evaluates the strategies used to address them. IHME makes this information widely available so that policymakers have the evidence they need to make informed decisions about how to allocate resources to best improve population health.

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