Alcohol-related deaths in the U.S. more than double from 1999 to 2020

Researchers from Florida Atlantic University's Schmidt College of Medicine explored U.S. trends in alcohol-related deaths from 1999 to 2020 overall as well as by age, gender, race and region, using the publicly available U.S. Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research (WONDER).

Results of the clinical research study, published in The American Journal of Medicine, reveal that alcohol-related deaths in the U.S. have surged dramatically in the last two decades, with the mortality rate nearly doubling 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, a dramatic twofold increase. Every age group has suffered increases, with the most alarming spike -- nearly fourfold -- in those aged 25 to 34.

The 85 and older age group saw a possible but nonsignificant increase. Additionally, 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.

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.

"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 Panagiota "Yiota" Kitsantas, Ph.D., senior and corresponding author and professor and chair of the Department of Population Health and Social Medicine, FAU Schmidt College of Medicine. "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."

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 also guide health care strategies.

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

Additionally, findings from the study generate testable hypotheses for future research, which combined with further basic studies, will enable more informed clinical decisions and public health policies. In the meantime, the data suggest actionable solutions for health care providers and public health officials at all levels.

"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 Charles H. Hennekens, M.D., FACPM, co-author, the first Sir Richard Doll Professor of Medicine and Preventive Medicine in the departments of medicine and population health and social medicine, and senior academic advisor, FAU Schmidt College of Medicine. "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."

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.

"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."

The authors say health care providers should be aware that in the U.S. as well as most populations throughout the world, individuals who consume large amounts of alcohol tend to have the highest risks of mortality as well as deaths from cardiovascular disease, which are predominantly due to heart attacks and stroke.

Co-authors are Alexandra Matarazzo, first author and a second-year FAU medical student; John Dunn, a second-year FAU medical student; Katerina Benson, a third-year premedical student at FAU; Yanna Willett, a third-year premedical student at Virginia Tech; Robert S. Levine, M.D., FACPM, an affiliate professor of family medicine, FAU Schmidt College of Medicine; and Maria C. Mejia, M.D., a professor, Department of Population Health and Social Medicine, FAU Schmidt College of Medicine.