One in Eight U.S. Adult Deaths Involved Too Much Booze

One out of every eight deaths in Americans ages 20 to 64 resulted from drinking too much alcohol, according to a U.S. population-based study.

Nationally, 12.9% of total deaths per year among adults in this age group were attributed to excessive alcohol consumption from 2015 to 2019, and that number rose to 20.3% of total deaths per year when restricted to people ages 20 to 49, reported Marissa Esser, PhD, MPH, of the CDC in Atlanta, and colleagues.

Alcohol-attributed deaths ranged from 9.3% in Mississippi to 21.7% in New Mexico and were more common among men than women (15% vs 9.4%), the authors wrote in JAMA Network Open.

“These premature deaths could be reduced through increased implementation of evidence-based alcohol policies (e.g., increasing alcohol taxes, regulating alcohol outlet density), and alcohol screening and brief intervention,” the authors concluded.

Alcohol consumption remains a leading preventable cause of premature death, with rates rising for alcoholic liver disease among young adults up to age 64, Esser’s group noted. A prior CDC report from 2006 to 2019 attributed one in 10 deaths to excessive alcohol consumption among adults ages 20 to 64, but it was largely based on self-reported data without consideration of per capita alcohol sales.

“Compared with 2019, death rates involving alcohol as an underlying or contributing cause of death increased during the first year of the COVID-19 pandemic in 2020, including among adults aged 20 to 64 years,” Esser’s group wrote. “Therefore, the proportion of deaths due to excessive drinking among total deaths might be higher than reported in this study.”

However, researchers added that their findings were in line with the epidemiology of excessive drinking. Other studies have shown deaths related to alcohol use disorder continued to rise from 2020 to 2021, while pandemic drinking took a toll on the gut and liver.

“Other studies have highlighted the number of deaths from causes that are fully attributable to alcohol use (e.g., alcohol poisoning, alcohol dependence, alcoholic liver disease), but that doesn’t capture the full burden of alcohol-related deaths,” Esser said. “This study is a comprehensive assessment that includes causes of deaths that are 100% related to alcohol and those that are partially related to alcohol, such as cancer and injuries.”

For this population-based study, Esser and colleagues examined data on 2,089,287 participants who responded to surveys on alcohol consumption from the Behavioral Risk Factor Surveillance System from 2015 through 2019. To correct for underreporting, mean daily alcohol consumption was adjusted to 73% of national per capita alcohol sales. Acute partially alcohol-attributable deaths, such as from cancer, were assessed by alcohol-attributed fractions in accordance with blood alcohol concentrations.

The CDC’s alcohol-related disease impact application was used to define alcohol-attributed deaths for 58 causes, while mortality data came from the National Vital Statistics System’s WONDER database.

Of the 140,557 mean annual deaths attributed to excessive alcohol (5% of total deaths nationally), 89,697 were individuals ages 20 to 64, or nearly two-thirds of the deaths, the researchers noted.

Although the number of alcohol-attributed deaths per 100,000 increased across age groups, those deaths comprised a larger proportion of total deaths for adults ages 20 to 34 (25.4%) compared with those ages 35 to 49 (17.5%). In the younger group, alcohol-attributed deaths were most frequently “other” poisonings (28%), followed by motor vehicle crashes and homicides (24% and 20%, respectively). For those ages 35 to 49 years, the leading cause was poisonings (24%), followed by alcoholic liver disease and motor vehicle crashes (18% and 12%).

The authors acknowledged limitations to the data. Alcohol-attributed deaths may also be conservative estimates since they were based on alcohol-related conditions that were identified only as the cause of death and excluded any contributing causes of death. Alcohol-attributed deaths that were partially caused by alcohol-related conditions were not assessed in those who formerly consumed excessive alcohol.