About the MIDAS Alcohol Data

Number:

• If you want to understand what the magnitude or how big the overall burden is, then use the number.
• The number indicates the total number of deaths or hospitalizations/ED visits due to alcohol-related conditions.
• For hospital/ED visits, the number refers to the number of visits (individuals may be counted more than once).
• To protect an individual's privacy, counts from 1 to 5 are suppressed.

Age-adjusted Rate:

• Age-adjusted rates are useful when comparing the rates of two population groups that have different age distributions.
• A weighted average, called the direct method, is used to adjust for age in this analysis. Age-specific rates in a given population are adjusted to the age distribution in a standard population by applying a weight. The U.S. 2000 Standard population is used as the basis for weight calculations.
• To limit the unreliability of rates, those based on counts < 6 are not calculated if the underlying population is less than or equal to 100,000.

Age-specific rate:

• A rate of an event (such as disease or death) measured within a particular age group. It is similar to a crude rate but is calculated within an age group (e.g. an age-specific rate of hospitalizations in adults 35-44 years of age).

Deaths due to excessive alcohol use can be broken into two primary groups.

• Alcohol-attributable deaths: Some causes of death are, by definition, 100% attributable to excessive alcohol use. These include 12 chronic causes such as alcoholic liver disease or gastritis, and three acute causes such as alcohol poisoning.
• Alcohol-related deaths: For other causes of death, especially acute causes such as injuries, alcohol is a contributing factor in a proportion of the deaths from those conditions. CDC’s Alcohol-Related Disease Impact (ARDI) application uses estimates of alcohol-attributable fractions from research to estimate the number of deaths from these causes that were due to alcohol. This report describes both groups—with “alcohol-related deaths” referring to the combination of 100% alcohol-attributable deaths and deaths from causes that are estimated using alcohol-attributable fractions.

Excessive alcohol use can lead to a variety of acute and chronic conditions. When severe enough, these conditions can require hospital care. 100% alcohol-related hospital visits refer to visits for acute and chronic conditions that are, by definition, fully attributable to alcohol.
The data provided here show the number of hospital and ED visits due to 100% alcohol-related conditions. Because personal identifiers are removed from the hospital discharge data before analysis, individuals who have multiple hospitalizations or ED visits cannot be identified
Hospitalization and ED data are extracted from Minnesota Hospital Discharge Data (MNHDD), which is maintained by the Minnesota Hospital Association (MHA).

• MHA represents Minnesota's hospitals and health systems. Hospitals submit ED and inpatient discharge data to MHA using a standardized billing form. Submitting data to MHA is voluntary, but the MNHDD typically represents data from more than 95% of hospitals (with some variation year to year).
• MHA began data-sharing agreements with several states in 2005. Minnesota residents receiving care from Emergency Departments and hospitals from the participating border states of North Dakota, South Dakota and Iowa are also included in hospitalization measures. MHA data are periodically revised by the MHA to reflect more complete and accurate discharge information.

Hospital visits where a condition considered 100% alcohol attributable are in any diagnosis field are considered Alcohol-related. The following ICD 10-CM codes are included:

• E24.4: Alcohol-induced pseudo-Cushing's syndrome
• F10.1[0-2,4-5,8-9]: Alcohol abuse
• F10.2[0-9]: Alcohol dependence
• F10.9[2,4-9]:   Alcohol use, unspecified
• G31.2: Degeneration of nervous system due to alcohol
• G62.1: Alcoholic polyneuropathy
• G72.1: Alcoholic myopathy
• I42.6: Alcoholic cardiomyopathy
• K29.2[0-1]: Alcoholic gastritis
• K70.0: Alcoholic fatty liver
• K70.1[0-1]: Alcoholic hepatitis
• K70.2: Alcoholic fibrosis and sclerosis of liver
• K70.3[0-1]: Alcoholic cirrhosis of liver
• K70.4[0-1]: Alcoholic hepatic failure
• K70.9: Alcoholic liver disease, unspecified
• K85.2[0-2]: Alcohol induced acute pancreatitis
• K86.0: Alcohol-induced chronic pancreatitis
• O35.4XX[0-5,9]: Maternal care for (suspected) damage to fetus from alcohol
• O99.31[0-5]: Alcohol use complicating pregnancy, childbirth, and the puerperium
• P04.3: Newborn affected by maternal use of alcohol
• Q86.0: Fetal alcohol syndrome (dysmorphic)
• T51.0X[1A-4S]: Toxic effect of ethanol
• T51.9[1-4,XA-XS]: Toxic effect of unspecified alcohol
• Y90.4-8: Blood alcohol level > 80 mg/100 ml

Alcohol-attributable death data are extracted from the Minnesota Death Certificate data. A death is considered alcohol-attributable if the underlying cause of death is one of the following ICD-10 codes:

• F10.0-9: Alcohol abuse and dependence
• G31.2: Degeneration of nervous system due to alcohol
• G62.1: Alcoholic polyneuropathy
• G72.1: Alcoholic myopathy
• I42.6: Alcoholic cardiomyopathy
• K29.2: Alcoholic gastritis
• K70.0: Alcoholic fatty liver
• K70.1: Alcoholic hepatitis
• K70.2: Alcoholic fibrosis and sclerosis of liver
• K70.3: Alcoholic cirrhosis of liver
• K70.4: Alcoholic hepatic failure
• K70.9: Alcoholic liver disease, unspecified
• K86.0: Alcohol-induced chronic pancreatitis
• O35.4: Maternal care for (suspected) damage to fetus from alcohol
• P04.3: Newborn affected by maternal use of alcohol
• Q86.0: Fetal alcohol syndrome (dysmorphic)
• R78.0: Finding of alcohol in blood
• T51.0: Ethanol poisoning
• T51.1: Methanol poisoning
• T51.9: Alcohol poisoning, unspecified
• X45: Accidental poisoning by and exposure to alcohol
• X65: Intentional self-poisoning by and exposure to alcohol
• Y15: Poisoning by and exposure to alcohol, undetermined

Hospital Discharge Data Limitations

• Hospital Discharge Data includes data for hospital visits rather than for individual people. To the extent possible, the data are not duplicated. However, multiple hospital visits by the same patient for the same condition/injury may be included.
• We are only able to capture the burden of conditions that are 100% attributable to alcohol for hospitalization and ED data. This leads to an underestimate of the overall burden of excessive alcohol use on the health care system because alcohol contributes to a wide variety of chronic and acute conditions that are not captured in these data.
• Minnesota residents discharged from Wisconsin hospitals are not included, so hospitalization and ED visit rates for counties in which residents are likely to receive care from Wisconsin may be underestimated. Rates for counties in which residents are likely to visit hospitals that do not submit data to the Minnesota Hospital Association (e.g., Veteran's Administration or Indian Health Services hospitals) may also be artificially low.

Death Certificate Data Limitations

• Beginning in 2017, we do not have the death records for those Minnesota residents who died in another state.
• There may be cases where the underlying cause of death does not fall within the alcohol-attributable death case definition, but in fact are attributable to alcohol. Similar to hospital discharge data, we were only able to provide data on those deaths that are 100% alcohol attributable, but alcohol is a contributing cause to a variety of other causes of death that are not included here.