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Binge Drinking Among Adults, by Select Characteristics and State — United States, 2018

Abstract and Introduction

Introduction

Excessive alcohol use* is associated with disease, injury, and poor pregnancy outcomes and is responsible for approximately 95,000 deaths in the United States each year.[1] Binge drinking (five or more drinks on at least one occasion for men or four or more drinks for women) is the most common and costly pattern of excessive alcohol use.[2] CDC analyzed data from the 2018 Behavioral Risk Factor Surveillance System (BRFSS) to estimate past 30-day binge drinking prevalence, frequency, and intensity (number of drinks per occasion), overall and by select characteristics and state. The overall unadjusted prevalence of binge drinking during the past 30 days was 16.6%, representing an estimated 38.5 million U.S. adults aged ≥18 years; prevalence was highest (26.0%) among those aged 25–34 years. The age-standardized binge drinking prevalence was higher among men (22.5%) than among women (12.6%), increased with income, and was highest among non-Hispanic White adults and adults in the Midwest Census region. State-level age-standardized binge drinking prevalence ranged from 10.5% (Utah) to 25.8% (Wisconsin). Among adults who reported binge drinking, 25.0% did so at least weekly, on average, and 25.0% consumed at least eight drinks on an occasion. To reduce binge drinking, the Community Preventive Services Task Force recommends increasing alcohol taxes and implementing strategies that strengthen regulations to reduce alcohol availability. The U.S. Preventive Services Task Force recommends clinicians screen adults for alcohol misuse in primary care settings and provide counseling as needed.§

BRFSS is an ongoing, state-based, random-digit–dialed, landline and cellular telephone survey of the U.S. noninstitutionalized adult population that collects health-related data nationwide. In 2018, the median survey response rate** for all states and the District of Columbia was 49.9% (range = 38.8%–67.2%).†† CDC analyzed data from 398,485 respondents aged ≥18 years in the 2018 BRFSS to estimate past 30-day binge drinking prevalence, frequency, and intensity. Binge drinking prevalence and frequency were assessed with the question, “Considering all types of alcoholic beverages, how many times during the past 30 days did you have 5 (4 for women) or more drinks on an occasion?”§§ Intensity was assessed with the question, “During the past 30 days, what is the largest number of drinks you had on any occasion?”.[3] Unadjusted and age-standardized (to the 2000 U.S. standard population) binge drinking prevalence and 95% confidence intervals (CIs) were estimated overall. Age-standardized prevalence was also estimated by respondents’ sociodemographic characteristics (except prevalence by age group), including sex, race/ethnicity, income, marital status, veteran status, education, region, county urbanization level,¶¶ and state. State-level prevalence estimates and 95% CIs were grouped into tertiles to identify geographic patterns. Because of the highly right-skewed distribution of the data, similar measures of binge drinking frequency and intensity among adults reporting binge drinking were estimated with medians and variances derived using Taylor series linearization. The means and 75th and 90th percentiles for frequency and intensity were also calculated to further characterize the distributions of these measures. Statistically significant differences between medians were defined as p<0.05 using pairwise tests and nonoverlapping CIs. All analyses were performed using SAS-callable SUDAAN (version 11.0.3; RTI International), and sampling weights were applied to account for complex sampling design, including nonresponse bias and noncoverage errors, and to improve representation of the adult U.S. population in different states.

In 2018, the overall nationwide unadjusted binge drinking prevalence among U.S. adults was 16.6% (95% CI = 16.3%–16.8%), representing an estimated 38.5 million adults (Table 1); prevalence was highest among adults aged 25–34 years (26.0%). Age-standardized binge drinking prevalence was 17.4% (95% CI = 17.2%–17.7%) and varied by sociodemographic group and by state (range = 10.5% [Utah] to 25.8% [Wisconsin]) (Figure) (Supplementary Table, https://stacks.cdc.gov/view/cdc/110373). Binge drinking prevalence was significantly higher among men (22.5%) than among women (12.6%) and was highest among non-Hispanic White adults (19.7%), those with annual household incomes ≥$75,000 (21.4%), those who were never married (18.5%) or were divorced/separated/widowed (19.4%), and veterans (20.9%). Binge drinking prevalence was significantly higher among adults with a college degree (18.9%) than among adults with less than a high school diploma (14.9%). States with higher binge drinking prevalences clustered in the Midwest and Northeast.

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Figure.

Prevalence of binge drinking* among adults aged ≥18 years — Behavioral Risk Factor Surveillance System, United States, 2018
Abbreviation: DC = District of Columbia.
*Respondents who reported consuming five or more alcoholic drinks (men) or four or more alcoholic drinks (women) on at least one occasion in the past 30 days.
State prevalence estimates are divided into tertiles.

Among adults who reported binge drinking, the median frequency was 1.7 (mean = 4.6) binge drinking occasions during the past 30 days, and the median intensity was 5.5 (mean = 7.2) drinks on an occasion. (Table 2). The upper frequency quartile was >4.0 (95% CI = 3.9–4.1) binge drinking occasions in the past 30 days and the upper intensity quartile was >7.7 (95% CI = 7.6–7.8) drinks on an occasion. Median binge drinking frequency and intensity were significantly higher among men (1.9 occasions and 5.9 drinks, respectively) than among women (1.4 occasions and 4.5 drinks, respectively), and decreased with education level. Median binge drinking intensity was highest among adults aged 18–24 years and decreased with age. Median binge drinking frequency among states ranged from 1.5 occasions (eight states) to 2.1 occasions (Mississippi) in the past 30 days; median binge-drinking intensity on an occasion ranged from 5.2 drinks (New Jersey, District of Columbia, and Connecticut) to 6.4 drinks (West Virginia).

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