AbstractIntroductionThe health impact from alcohol is of recognised concern, from acute intoxication as well as increased risk of chronic health issues over time. Identifying factors associated with higher alcohol consumption when presenting to the emergency department (ED) will inform public health policy and enable more targeted health care and appropriate referrals.MethodsSecondary testing of blood samples collected during routine clinical care of 1160 ED patients presenting to the Royal Brisbane and Women's Hospital in Queensland, Australia, for 10 days between 22 January and 1 February 2021. Alcohol was measured by blood ethanol (intake in recent hours) and phosphatidylethanol (PEth; intake over 2–4 weeks). Zero‐inflated negative binomial regression was used to identify demographic and clinical factors associated with higher alcohol concentrations.ResultsMales were found to have 83% higher blood ethanol and 32% higher PEth concentrations than females (adjusted rate ratio [ARR] 1.83, 95% confidence interval [CI] 1.37–2.45 and ARR 1.32, 95% CI 1.04–1.68, respectively). Blood ethanol concentrations were 3.4 times higher for those 18–44 years, compared to those aged 65+ (ARR 3.40, 95% CI 2.40–4.82) whereas PEth concentrations were found to be the highest in those aged 45–64 years, being 70% higher than those aged 65+ (ARR 1.70, 95% CI 1.19–2.44). Patients brought in involuntarily had eight‐times higher blood ethanol concentrations than those who self‐attended.Discussion and ConclusionsThis study used two alcohol markers to identify factors associated with higher alcohol concentrations in emergency presentations. The findings demonstrate how these biomarkers can provide informative data for public health responses and monitoring of alcohol use trends.