An analysis of U.S. death certificate data by researchers at the National Institute on Alcohol Abuse and Alcoholism (NIAAA), part of the National Institutes of Health, found that nearly 1 million people died from alcohol-related causes between 1999 and 2017. The number of death certificates mentioning alcohol more than doubled from 35,914 in 1999 to 72,558 in 2017, the year in which alcohol played a role in 2.6% of all deaths in the United States. The increase in alcohol-related deaths is consistent with reports of increases in alcohol consumption and alcohol-involved emergency department visits and hospitalizations during the same period. The new findings are reported online in the journal Alcoholism: Clinical and Experimental Research.

“Alcohol is not a benign substance and there are many ways it can contribute to mortality,” said NIAAA Director Dr. George F. Koob. “The current findings suggest that alcohol-related deaths involving injuries, overdoses, and chronic diseases are increasing across a wide swath of the population. The report is a wakeup call to the growing threat alcohol poses to public health.”

In the new study, Aaron White, Ph.D., senior scientific advisor to the NIAAA director, and colleagues analyzed data from all U.S. death certificates filed from 1999 to 2017.  A death was identified as alcohol-related if an alcohol-induced cause was listed as the underlying cause or as a contributing cause of death.  The researchers found that, in 2017, nearly half of alcohol-related deaths resulted from liver disease (31%; 22,245) or overdoses on alcohol alone or with other drugs (18%; 12,954). People aged 45-74 had the highest rates of deaths related to alcohol, but the biggest increases over time were among people age 25-34. High rates among middle-aged adults are consistent with recent reports of increases in “deaths of despair,” generally defined as deaths related to overdoses, alcohol-associated liver cirrhosis, and suicides, primarily among non-Hispanic whites. However, the authors report that, by the end of the study period, alcohol-related deaths were increasing among people in almost all age and racial and ethnic group.

As with increases in alcohol consumption and related medical emergencies, rates of death involving alcohol increased more for women (85%) than men (35%) over the study period, further narrowing once large differences in alcohol use and harms between males and females. The findings come at a time of growing evidence that even one drink per day of alcohol can contribute to an increase in the risk of breast cancer for women. Women also appear to be at a greater risk than men for alcohol-related cardiovascular diseases, liver disease, alcohol use disorder, and other consequences.

“Alcohol is a growing women’s health issue,” said Dr. Koob. “The rapid increase in deaths involving alcohol among women is troubling and parallels the increases in alcohol consumption among women over the past few decades.”

The authors note that previous studies have shown that the role of alcohol in deaths is vastly underreported. Since the present study examined death certificates only, the actual number of alcohol-related deaths in 2017 may far exceed the 72,558 determined by the authors.  

 “Taken together,” said Dr. Koob, “the findings of this study and others suggests that alcohol-related harms are increasing at multiple levels – from ED visits and hospitalizations to deaths. We know that the contribution of alcohol often fails to make it onto death certificates. Better surveillance of alcohol involvement in mortality is essential in order to better understand and address the impact of alcohol on public health.”

About the National Institute on Alcohol Abuse and Alcoholism (NIAAA): The National Institute on Alcohol Abuse and Alcoholism (NIAAA), part of the National Institutes of Health, is the primary U.S. agency for conducting and supporting research on the causes, consequences, diagnosis, prevention, and treatment of alcohol use disorder. NIAAA also disseminates research findings to general, professional, and academic audiences. Additional alcohol research information and publications are available at www.niaaa.nih.gov.

About the National Institutes of Health (NIH): NIH, the nation's medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit www.nih.gov.


Reference

Aaron White, PhD, I-Jen P. Castle, PhD, Ralph Hingson, ScD, Patricia Powell, PhD. Using death certificates to explore changes in alcohol-related mortality in the United States, 1999–2017 Alcoholism: Clinical and Experimental Research. Published online January 8, 2020.


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