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The Health Impact of Alcohol on American Cities: Modeling the Local Burden of Current Alcohol Use in One Jurisdiction


Measurement of alcohol use and associated harms at the city level is often incomplete or non-existent even though such data are often critical to informing local prevention strategies. This paper models how to generate local estimates of the morbidity, mortality, and cost of current alcohol use instead of abstaining. Administrative data sources, including medical examiner records, hospital records, and police records, among others, were used to obtain local estimates of alcohol-attributable outcomes. In 2018, we used alcohol-attributable fractions and scaled national estimates to quantify the burden of current alcohol use in Baltimore, MD, in 2013. Fifty-two percent of Baltimore adults reported past 30-day drinking. There were 276 alcohol-attributable deaths in 2013, and 106 (38.4%) of these were persons other than the drinker. In 2013, current alcohol use cost $582.3 million in Baltimore City. This burden was distributed across drinkers (40.1%), persons other than the drinker (21.3%), and the government (38.6%). It is possible to quantify this burden at the local level, and these data could be used to inform evidence-based alcohol policy strategies at the local level.

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We would like to thank Dr. Darcy Phelan-Emerick of the Baltimore City Health Department and Naomi Greene and Dr. Raimee Eck from Johns Hopkins Bloomberg School of Public Health for their help with this project. We would also like to thank the numerous people who helped us obtain data for this project: Dr. Linda Simoni-Wastila and Abree Johnson from the Maryland Statewide Epidemiological Outcomes Workgroup, who helped us identify data sources and connect to data custodians; Ceres Martin from the Behavioral Health Administration for providing the counts of alcohol treatment cases; Dr. Amanda Latimore and Tara Thallmayer from Behavioral Health System Baltimore for generating the cost estimates for alcohol dependence services; Oscar Ibarra from the Health Services Cost Review Commission for the help with the data request process and providing access to the hospital data; Tim Kerns and Doug Mowbray from the National Study Center for Trauma and EMS and the Maryland Department of Transportation’s Highway Safety Office, respectively, for extracting the non-fatal car crash data; and Jay Miller from the Department of Public Safety and Correctional Services who provided the corrections data.


This report was supported by Cooperative Agreement Number 5U48DP005045 from the Centers for Disease Control and Prevention. This manuscript was also supported by Award Numbers T32AA007240 (Graduate Research Training in Alcohol Problems: Alcohol-related Disparities) and P50AA005595 (Epidemiology of Alcohol Problems: Alcohol-Related Disparities from the National Institute on Alcohol Abuse and Alcoholism).

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Correspondence to Pamela J. Trangenstein.

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Trangenstein, P.J., Jernigan, D.H. The Health Impact of Alcohol on American Cities: Modeling the Local Burden of Current Alcohol Use in One Jurisdiction. J Urban Health 97, 260–270 (2020).

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  • Alcohol Drinking
  • Ethanol
  • Cost Analysis
  • Hospital Records
  • Coroner and Medical Examiners