Estimated Deaths Attributable to Excessive Alcohol Use Among US Adults Aged 20 to 64 Years, 2015 to 2019
Original Investigation
Key Points
Question
What is the estimated proportion of deaths among US adults aged 20 to 64 years attributable to alcohol consumption, and are there differences by sex, age, and US state?
Findings
The study assessed the effects of alcohol on people of working age, who accounted for nearly two-thirds of the country’s annual average of 140,000 alcohol-related deaths.
Although alcohol takes a progressively heavier toll on older age groups, its effects are more noticeable in younger people who are less likely to die of other causes. Among those aged 20 to 49, one in five deaths was due to alcohol, and for those ages 20 to 34, it was one in four, the study found, according to New York Times reporting.
The estimates in this cross-sectional study of 694,660 mean deaths per year between 2015 and 2019 suggest that “excessive alcohol consumption” accounted for 12.9% of total deaths among adults aged 20 to 64 years and 20.3% of deaths among adults aged 20 to 49 years.
Among adults aged 20 to 64 years, the proportion of alcohol-attributable deaths to total deaths varied by state.
Meaning
These findings suggest that an estimated 1 in 8 deaths among adults aged 20 to 64 years were attributable to alcohol use and that greater implementation of evidence-based alcohol policies could reduce this proportion.
This is really affecting adults in the prime of their life,” said Marissa Esser, who leads the US Centers for Disease Control and Prevention’s alcohol program and is a co-author of the study, as per New York Times.
The large share of people dying in their working years means alcohol has an outsize effect on economic productivity.”
Dr. Marissa Esser, study co-author, and lead, alcohol program, US Centers for Disease Control and Prevention (CDC)
Deaths due to alcohol is a leading cause of preventable death,” said lead study author Dr. Marissa Esser, who leads the US Centers for Disease Control and Prevention’s alcohol program, according to CNN reporting.
The data showed that the deaths fully attributable to alcohol have risen in the past decade.”
Dr. Marissa Esser, study co-author, and lead, alcohol program, US Centers for Disease Control and Prevention (CDC)
What the researchers define as “excessive” alcohol use
In the section on methods, the researchers also explain their definition of “excessive” alcohol use:
This study estimated deaths due to excessive alcohol consumption; therefore, for chronic conditions, the adjusted prevalence of medium (>1 to ≤2 alcoholic drinks for women or >2 to ≤4 drinks for men) and high (>2 alcoholic drinks for women or >4 drinks for men) mean daily alcohol consumption…”
Esser MB, Leung G, Sherk A, Bohm MK, Liu Y, Lu H, Naimi TS. Estimated Deaths Attributable to Excessive Alcohol Use Among US Adults Aged 20 to 64 Years, 2015 to 2019. JAMA Netw Open. 2022 Nov 1;5(11):e2239485. doi: 10.1001/jamanetworkopen.2022.39485. PMID: 36318209.
Using the term “excessive drinking” can be misleading, both by the wording and by the framing of alcohol harm as individual phenomenon.
Terms like “excessive drinking” imply that there is alcohol consumption that is not “excessive”. But what is it? What is normal? What is reasonable?
Other research shows, for instance, that even people who are heavy alcohol users positioned themselves as “responsible”, knowledgeable alcohol users and distanced themselves from “problem” alcohol users.
It is not with one glass of alcohol per day (or two) that alcohol damage starts. And using a limit for individuals’ consumption “presents” the issue as individualistic. But alcohol harm is a societal issue, driven by the products and practices of alcohol companies. There are also no means of ensuring that people in a population consume only a certain fixed amount of alcohol.
Findings are likely under-estimation of total death toll due to alcohol
The findings, albeit shocking figures of alcohol’s death toll in the US, are a conservative estimate. Researchers explain that there were deaths that alcohol likely contributed to that the study’s researchers could not include in their estimates. Some conditions may have had alcohol as a factor, but researchers were not able to verify for sure the role that alcohol use played.
In other cases, they were not able to determine if someone who died of an illness used to consume alcohol heavily but then stopped.
And people often underreport how much alcohol they are actually consuming.
Abstract
Importance
Alcohol consumption is a leading preventable cause of death in the US, and death rates from fully alcohol-attributable causes (eg, alcoholic liver disease) have increased in the past decade, including among adults aged 20 to 64 years. However, a comprehensive assessment of alcohol-attributable deaths among this population, including from partially alcohol-attributable causes, is lacking.
Objective
To estimate the mean annual number of deaths from excessive alcohol use relative to total deaths among adults aged 20 to 64 years overall; by sex, age group, and state; and as a proportion of total deaths.
Design, setting, and participants
This population-based cross-sectional study of mean annual alcohol-attributable deaths among US residents between January 1, 2015, and December 31, 2019, used population-attributable fractions. Data were analyzed from January 6, 2021, to May 2, 2022.
Exposures
Mean daily alcohol consumption among the 2 089 287 respondents to the 2015-2019 Behavioral Risk Factor Surveillance System was adjusted using national per capita alcohol sales to correct for underreporting. Adjusted mean daily alcohol consumption prevalence estimates were applied to relative risks to generate alcohol-attributable fractions for chronic partially alcohol-attributable conditions. Alcohol-attributable fractions based on blood alcohol concentrations were used to assess acute partially alcohol-attributable deaths.
Main outcomes and measures
Alcohol-attributable deaths for 58 causes of death, as defined in the Centers for Disease Control and Prevention’s Alcohol-Related Disease Impact application. Mortality data were from the National Vital Statistics System.
Results
During the 2015-2019 study period, of 694,660 mean deaths per year among adults aged 20 to 64 years (men: 432 575 [66.3%]; women: 262 085 [37.7%]), an estimated 12.9% (89,697 per year) were attributable to excessive alcohol consumption.
This percentage was higher among men (15.0%) than women (9.4%).
By state, alcohol-attributable deaths ranged from 9.3% of total deaths in Mississippi to 21.7% in New Mexico.
Among adults aged 20 to 49 years, alcohol-attributable deaths (44,981 mean annual deaths) accounted for an estimated 20.3% of total deaths.
Conclusions and relevance
The findings of this cross-sectional study suggest that an estimated 1 in 8 total deaths among US adults aged 20 to 64 years were attributable to excessive alcohol use, including 1 in 5 deaths among adults aged 20 to 49 years.
The number of premature deaths could be reduced with increased implementation of evidenced-based, population-level alcohol policies, such as increasing alcohol taxes or regulating alcohol outlet density.
States and communities can prevent these premature deaths using evidence-based strategies to reduce the availability and accessibility of alcohol and increase its price,” Dr Esser said, according to CNN reporting.
That can mean increasing taxes on alcohol or limiting where alcohol is sold.”
Dr. Marissa Esser, study co-author, and lead, alcohol program, US Centers for Disease Control and Prevention (CDC)
Policymakers should take steps to make their communities safer. Evidence-based strategies are out there and underused,” said Dr Esser, according to New York Times reporting.
The C.D.C.’s Community Preventive Services Task Force recommends a number of alcohol policy solutions, including raising alcohol taxes and regulating the number and concentration of businesses that sell alcohol.
Last year, the U.S. Congress permanently reduced federal alcohol tax rates, and state alcohol taxes have generally not kept up with inflation – making alcohol ever more affordable. But in some federal states with a high burden due to alcohol, people and communities have begun to demand change. In Oregon, there was a campaign to raise alcohol taxes, and lawmakers in New Mexico recently held hearings about doing so.