Alcohol-related fatalities in the United States rose sharply between 1999 and 2020, nearly doubling in number. The most significant rise was observed in individuals aged 25 to 34, whose death rates increased by almost four times. Conversely, the highest rates were found among those aged 55 to 64. While men consistently showed higher rates of alcohol-related deaths, women experienced the largest proportional increase, with rates growing 2.5 times. Additionally, the Asian and Pacific Islander populations saw the steepest increase, and the Midwest reported the highest increase regionally, followed by the Northeast, West, and South.
In the U.S. and around the globe, drinking alcohol is a leading cause of preventable mortality and disabilities, contributing to liver diseases, mental health issues, and accidents.
Researchers from the Schmidt College of Medicine at Florida Atlantic University examined trends in alcohol-related deaths across the U.S. from 1999 to 2020, considering factors such as age, gender, race, and geography, using publicly accessible data from the U.S. Centers for Disease Control and Prevention’s Wide-ranging Online Data for Epidemiologic Research (WONDER).
The findings, detailed in The American Journal of Medicine, indicate a dramatic rise in alcohol-related deaths in the U.S. over the past two decades, with the rate nearly doubling from 10.7 per 100,000 in 1999 to 21.6 per 100,000 in 2020. The total number of such deaths surged from 19,356 to 48,870— a substantial twofold increase. All age groups saw an uptick, with the most concerning rise — nearly fourfold — in the 25 to 34 age bracket.
A slight but non-significant increase was noted among those aged 85 and older. Meanwhile, individuals aged 55-64 experienced the highest mortality rates and significant increases from both 1999 and 2020. While both genders saw an uptick in alcohol-related deaths, men maintained the higher rates overall and experienced the largest increase. However, deaths among women ballooned from 4.8 per 100,000 in 1999 to 12 in 2020.
For women, the death toll rose 2.5 times, whereas the Asian and Pacific Islander communities observed the steepest rise of 2.4 times. Geographically, the Midwest showed the greatest increase in alcohol-related mortality at 2.5 times, followed by the Northeast, West, and South regions.
“Our research highlights significant differences in alcohol-related mortality between genders. While men have higher death rates overall, women have experienced a greater relative increase, which may reflect changing societal norms and the alcohol industry’s increased focus on marketing to women,” stated Panagiota “Yiota” Kitsantas, Ph.D., the senior author and professor at FAU’s Schmidt College of Medicine. “As women’s drinking patterns have evolved, so have the associated risks. Women seem to be more vulnerable to the harmful effects of alcohol, possibly due to differences in body composition and metabolism, which result in heightened blood alcohol levels. Additionally, mental health challenges like depression and anxiety, which are already more frequent in women, can be exacerbated by alcohol consumption.”
The study’s outcomes underscore urgent public health and clinical challenges that may benefit from specialized interventions. Factors such as obesity, diabetes, and liver damage make addressing these issues even more complex, accelerating the rates of alcohol-related deaths. Tailored health care strategies should consider gender, demographic, and geographic variations.
“Tackling these issues through specific interventions could play a key role in combating the escalating alcohol mortality crisis in the U.S.,” said Kitsantas.
Furthermore, the study’s findings create opportunities for future research. Coupling these insights with additional studies could lead to more informed health care decisions and public health strategies. Meanwhile, the results suggest immediate action for health care providers and public health officials at all levels.
“Healthcare professionals should understand that excessive alcohol consumption significantly increases the risk of overall mortality and cardiovascular diseases, particularly heart attacks and strokes,” emphasized Charles H. Hennekens, M.D., FACPM, co-author and senior academic advisor at FAU Schmidt College of Medicine. “To manage these risks, routine alcohol use screenings in primary care settings are vital. Coexisting factors such as overweight and obesity can expedite liver damage, potentially triggering earlier onset of cirrhosis and liver cancer. The U.S. has some of the highest rates of overweight and obesity globally, coupled with low levels of daily physical activity. The harmful interaction of these elements may explain the rising trends in alcohol-related deaths, especially among younger individuals.”
Global alcohol consumption patterns vary by region, including in the U.S. As of 2019, Latvia topped the list for annual per capita alcohol consumption at 13.2 liters, followed closely by France at 12.2 liters and the U.S. at 10 liters. Mortality data reveal intricate associations between alcohol use and premature deaths. For instance, Latvia leads both in alcohol use and ranks third in total deaths, while France, despite high alcohol intake, shows low rates of cardiovascular mortality but elevated incidences of cirrhosis and liver cancer. On the other hand, Russian males exhibit high alcohol consumption alongside increased cardiovascular mortality rates. These trends highlight the complex relationships between alcohol intake, early mortality, and disease, regardless of the type of beverage consumed.
“High levels of alcohol consumption, both globally and within the U.S., are strongly associated with premature mortality and disability,” remarked Hennekens. “The distinction between moderate and excessive alcohol consumption can drastically affect the risk of early death. One immediate consequence of alcohol is liver injury, and the escalating rates of obesity and diabetes in the U.S. further contribute to early liver damage.”
The authors advise health care providers that in the U.S. and many populations worldwide, those who consume significant amounts of alcohol face the highest mortality risks, particularly from cardiovascular diseases, predominantly heart attacks and strokes.
Co-authors of the study include Alexandra Matarazzo, the lead author and second-year medical student; John Dunn, another second-year 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 associate professor of family medicine at FAU; and Maria C. Mejia, M.D., a professor at the Department of Population Health and Social Medicine at FAU Schmidt College of Medicine.
