Alcohol-related deaths have doubled over the past two decades

In the United States and worldwide, alcohol consumption remains a leading cause of preventable death and disability, contributing to liver disease, mental health disorders, and accidents. 

Researchers from Florida Atlantic University (FAU)’s Schmidt College of Medicine have delved into U.S. trends in alcohol-related deaths from 1999 to 2020. 

Utilizing data from the U.S. Centers for Disease Control and Prevention’s Wide-ranging Online Data for Epidemiologic Research (WONDER), they uncovered alarming statistics.

Dramatic surge in alcohol-related deaths 

The study reveals that alcohol-related deaths in the U.S. have surged dramatically in the last two decades. The mortality rate nearly doubled from 10.7 per 100,000 in 1999 to 21.6 per 100,000 in 2020. 

The total number of alcohol-related deaths soared from 19,356 to 48,870, marking a dramatic twofold increase. Every age group experienced increases, with the most alarming spike – nearly fourfold – in those aged 25 to 34.

Gender and age disparities

The 85 and older age group saw a possible but nonsignificant increase. Individuals aged 55-64 had both the steepest rise in mortality and the highest absolute rates in both 1999 and 2020. 

Both men and women experienced significant increases in alcohol-related deaths, but men had the highest rates in both years and saw the steepest increase overall. 

Women, however, saw the largest proportional rise, with deaths increasing from 4.8 per 100,000 in 1999 to 12 in 2020.

Alcohol consumption among women 

Study senior author Dr. Panagiota “Yiota” Kitsantas is a professor and chair of the Department of Population Health and Social Medicine at FAU. 

“Our study found significant gender differences in alcohol-related mortality. While men had higher overall death rates, women experienced a larger relative increase, which may reflect changing social norms and the alcohol industry’s increased targeting of women through marketing campaigns,” said Dr. Kitsantas.

“As alcohol consumption among women has grown, so have the associated risks. Women appear to be more vulnerable to alcohol’s harmful effects due, possibly, to differences in body composition and metabolism, leading to higher blood alcohol concentrations.” 

Moreover, mental health issues like depression and anxiety, already more common in women, can be worsened by alcohol use, noted Dr. Kitsantas.

Regional variations in alcohol-related deaths 

Deaths in women increased two-and-a-half times, while Asian and Pacific Islander communities experienced the steepest rise of 2.4 times. 

Regionally, the Midwest experienced the greatest jump, with an increase of 2.5 times in alcohol-related mortality, followed by the Northeast, West, and South.

“Addressing these factors through tailored interventions could help combat the growing U.S. alcohol mortality epidemic,” said Dr. Kitsantas.

Complications of associated risk factors

Findings from the study highlight significant clinical and public health challenges that may benefit from targeted interventions. 

Risk factors such as obesity, diabetes, and liver damage complicate these challenges, accelerating alcohol-related mortality. Gender, demographic, and regional differences should guide healthcare strategies.

“Health care providers should recognize that heavy alcohol use is a leading risk factor for total mortality and cardiovascular disease, especially heart attacks and stroke,” said co-author Charles H. Hennekens, a professor of medicine at FAU. 

“To mitigate these risks, screening for alcohol use in primary care settings is essential. Coexisting conditions like overweight and obesity can accelerate liver damage, which may in turn lead to earlier onset of cirrhosis and liver cancer.”

“The U.S. has the highest rates of overweight and obesity in the world and low levels of daily physical activity. The deleterious interaction of these factors may contribute to the observed trends in alcohol-related mortality, particularly in younger adults.”

Global context and future directions

Alcohol consumption varies significantly by region worldwide and in the U.S. According to 2019 data, Latvia had the highest annual per capita consumption at 13.2 liters, followed by France at 12.2 and the U.S. at 10. 

Descriptive data on mortality reveal complex links between alcohol use and premature deaths. Latvia, for example, leads in alcohol consumption and ranks third in total deaths, while France, despite high alcohol consumption, has low cardiovascular mortality but high rates of cirrhosis and liver cancer. 

In contrast, Russian men have high alcohol consumption and an elevated rate of cardiovascular mortality. These patterns illustrate the complex interrelationships of alcohol consumption, premature death, and disease, regardless of the beverage type.

Alcohol consumption and premature death

“Both globally and in the U.S., high levels of alcohol consumption are closely linked to premature deaths and disability,” said Hennekens. 

“The difference between consuming small amounts of alcohol daily and larger amounts could be the difference between preventing and causing premature death. One immediate effect of alcohol is liver damage, and in the U.S., the rising rates of obesity and diabetes also contribute to early liver damage.”

In conclusion, the authors emphasize that healthcare providers should be aware that in the U.S. as well as most populations worldwide, individuals who consume large amounts of alcohol tend to have the highest risks of mortality as well as deaths from cardiovascular disease, predominantly due to heart attacks and stroke.

The research is published in The American Journal of Medicine.

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