March 2, 2020

A new study from researchers at the University of North Carolina at Chapel Hill and Boston University estimates that health and safety problems attributable to alcohol use cost $582.3 million in Baltimore City in 2013 — the equivalent of approximately $2.04 per drink.

The study included costs from lost productivity; health care costs for chronic diseases such as liver cirrhosis, pancreatitis, hypertension and stroke, as well as acute outcomes such as traffic crashes and falls; and costs of services such as police, emergency transport, fire and rescue, and special education needed by children born with alcohol-related birth defects.

Of the total, governments (city, state and federal) paid 38.6% or $224.5 million. For example, Baltimore City spent $61.0 million on direct costs like health care, police services, emergency transports and special education that resulted from alcohol use in 2013 — the same year the city had a $48 million budget deficit.

Dr. Pamela J. Trangenstein

Dr. Pamela J. Trangenstein

“Cities are constantly making decisions about alcohol — what new outlets to allow, how long they can be open and so on,” said lead study author Pamela J. Trangenstein, PhD, an assistant professor in the Department of Health Behavior at the UNC Gillings School of Global Public Health. “But they are doing this without having the whole picture — previous studies of alcohol’s burden in Baltimore missed more than half the outcomes that alcohol can cause. It’s hard to make good decisions with incomplete data.”

While data on the burden and costs of alcohol are available at the state and national level (PDF), this study is the first to estimate the costs for a city in the United States. It also offers a straightforward model for other cities, using currently available data such as electronic health records, police records and chief medical examiner data.

Additionally, the study found that:

  • While only half (52.5%) of Baltimore adults drank alcohol in 2013, drinkers directly paid less than half (40.1%) of the costs of alcohol.
  • Approximately one in six (16.7%) Baltimore adults were binge drinkers, defined as men consuming five or more drinks or women consuming four or more drinks within about two hours. Binge drinkers cost Baltimore businesses $26,000 per working day through absences related to their drinking.
  • In 2013, Baltimore prisons housed 894 persons who committed alcohol-attributable crimes, at a cost to the city of $13,331 per day.
  • The number of Baltimoreans who died from alcohol-attributable causes in 2013 — 276 people — exceeded deaths in the city (PDF) from leading causes such as breast cancer (103), diabetes (196) and hypertensive heart disease (251) that year.
  • Overall, alcohol was responsible for 4.3% of all deaths in Baltimore in 2013, and an even larger share of deaths among youth: One in three (33.6%) 15-24-year-olds, one in four (24.5%) 25-34-year-olds, and one in ten (10.9%) 35-49-year-olds died from alcohol-attributable causes.
  • Most (71.1%) of the costs for treating alcohol-attributable conditions in non-federal hospitals stemmed from chronic conditions like liver cirrhosis, pancreatitis, hypertension and stroke, rather than acute intoxication-related harms such as traffic crashes and falls.

The study assumed that the hospitalizations, deaths and direct costs from alcohol problems could have been avoided.

According to senior author David Jernigan, PhD, a professor in the Department of Health Law, Policy and Management at the Boston University School of Public Health: “We know which policies work to reduce these costs. Higher taxes on alcohol could help it pay for itself and reduce consumption, while restricting alcohol marketing and the times and places alcohol can be sold can affect how much people drink and the problems they have. Unfortunately, these policies are too often underutilized.”

In 2013, Baltimore sold about 13.3 million gallons of alcohol (PDF), enough to fill approximately 165 thousand bathtubs. The Baltimore City government subsidized each alcoholic drink by 11 cents in 2013: While alcohol taxes and liquor licensing fees brought in approximately 10 cents, direct costs for health care and other services totaled 21 cents.

“Cities need to understand the real costs of alcohol,” said Trangenstein. “In this study, we sought to show how, with existing data, cities can calculate those costs and equip themselves to make more informed decisions about alcohol policies.”

This study was partially supported by the Centers for Disease Control and Prevention and the National Institute on Alcohol Abuse and Alcoholism. It was published online by the Journal of Urban Health on March 2.


Contact the Gillings School of Global Public Health communications team at sphcomm@unc.edu.

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