Trends in Alcohol-Related Deaths by Sex in the US, 1999-2020
Original Investigation, Substance Use and Addiction
Summary
In this cross-sectional study of deaths due to alcohol in the US, male individuals had a significantly higher burden of alcohol-involved mortality than females. However, trends reveal a significantly higher rate of increase in deaths due to alcohol among women in the US compared to men.
Researchers looked at data from 1999 to 2020, with 2020 being the most recent year for which data are accessible. A selected number of ICD-10 codes were used to identify alcohol-related deaths. Using this definition of alcohol-related mortality, researchers specifically excluded deaths resulting from unintentional injuries, homicides, and other causes of death that are indirectly or partially linked with alcohol use.
Between 1999 and 2020, a total of 605, 948 individuals died in the US due to alcohol-related causes, resulting in an age-adjusted alcohol related mortality rate of 8.3 per 100,000 persons. Men had a significantly higher mortality rate compared with women, with men being 2.88 times more likely to die from alcohol-related causes. This sex disparity in deaths due to alcohol burden persisted across various subcategories, including age, race and ethnicity, census region, and cause of death.
Temporal trends showed an increase in alcohol deaths for both men and women in recent years, with higher rates of increase among women relative to men in the US.
Male individuals had a stable level of alcohol use from 1999 to 2009, with increasing trends of alcohol consumption at an annual rate of 3.0% from 2009 to 2018 and 12.5% from 2018 to 2020.
Female individuals had a slightly different trend of alcohol use, with a 1.0% per year increase from 1999 to 2007, followed by a larger increase of 4.3% per year from 2007 to 2018, and an even larger increase of 14.7% per year from 2018 to 2020.
| Period | Men (annual alcohol use increase) | Women (annual alcohol use increase) |
| 1999–2009 | 0% | +1% |
| 2009–2018 | +3% | +4.3% |
| 2018–2020 | +12.5% | +14.7% |
The findings show a trend of increasing rates of deaths due to alcohol among women, indicating a narrowing sex gap. These trends may be associated with a combination of sociocultural, economic, biological, and behavioural factors, including the normalization of cultural practices surrounding alcohol consumption.
The development of targeted interventions and evidence-based treatments for alcohol use among female individuals becomes imperative in effectively addressing the increasing rates of alcohol-related deaths.
Key Points
Question
Are there sex-based differences in the contemporary burden and trends of deaths due to alcohol in the US?
Findings
In this cross-sectional study of 605,948 alcohol deaths, men had a significantly higher burden of mortality due to alcohol than did women in the US, with a male to female ratio of 2.88.
Temporal trends revealed an increase in deaths due to alcohol among both sexes, with a significantly higher rate of increase observed for women than for men in the US.
Meaning
Although deaths due to alcohol have historically been more prevalent among men than women, recent temporal trends suggest a narrowing of this gap, with increasing rates of alcohol deaths among females compared with males.
The development of targeted interventions and evidence-based treatments for alcohol use among female individuals becomes imperative in effectively addressing the increasing rates of alcohol-related deaths.
Key quotes
Even if [people] have been a consistent [alcohol users] throughout [their] life, scaling back now can help to reduce risk,” said Johannes Thrul, an associate professor at the Johns Hopkins Bloomberg School of Public Health, as per New York Times reporting.
In the short term, [people] are lowering the chance of injuring [themselves]; over time, [people] lessen the potential for chronic health issues associated with alcohol use”
Johannes Thrul, associate professor, Johns Hopkins Bloomberg School of Public Health
Dr. Ibraheem Karaye, an assistant professor of population health at Hofstra University and the lead author of the study agreed, according to New York Times reporting:
Reducing or eliminating [alcohol] exposure at any point would be valuable.”
Dr. Ibraheem Karaye, assistant professor of population health, Hofstra University, and lead author of the study
Johannes Thrul, an associate professor at the Johns Hopkins Bloomberg School of Public Health added, as per New York Times:
Really, low-risk [alcohol use] is not [consuming alcohol] at all,” Dr. Thrul said.
This is something that society is just starting to understand.”
Johannes Thrul, associate professor, Johns Hopkins Bloomberg School of Public Health
Abstract
Importance
Alcohol consumption rates have been increasing among women in the US, which may affect mortality rates and sex gaps. Therefore, conducting a comprehensive assessment of sex differences in alcohol-related deaths is essential to inform targeted interventions and policies aimed at reducing the burden of alcohol-related harm among the population.
Objective
To examine sex differences in the burden and trends of alcohol-related mortality in the US from 1999 to 2020.
Design, Setting, and Participants
This cross-sectional time series study used Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research data on alcohol-related deaths from 1999 to 2020.
Alcohol-related deaths were identified from the underlying cause of death files using International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, codes, including alcohol-related poisoning, liver disease, gastritis, cardiomyopathy, myopathy, polyneuropathy, and pseudo-Cushing syndrome, among others.
Main Outcomes and Measures
Age-adjusted mortality rates (AAMRs) were analyzed by sex and substratified by race and ethnicity, age, and census region. Rate ratios and 95% CIs calculated by Taylor series were used to assess sex differences in mortality burden. Joinpoint regression was used to assess temporal trends.
Results
A total of 605, 948 alcohol-attributed deaths were identified in the US from 1999 through 2020 (AAMR, 8.3 per 100,000 persons; 95% CI, 8.3-8.3 per 100,000 persons).
The mortality burden was higher among male individuals than female individuals, with male individuals being 2.88 times more likely to die compared with female individuals.
However, temporal trends showed an increase in alcohol-related deaths for both male and female individuals in recent years, with higher rates of increase among female individuals relative to male individuals. The AAMR increased by 12.5% per year among male individuals from 2018 to 2020 but increased by 14.7% per year among female individuals during the same period.
Trend differences were observed across subtypes of age, race and ethnicity, cause, and region.
Conclusions and Relevance
This study of alcohol-related mortality in the US suggests there has been a significantly higher rate of increase in deaths among female individuals in recent years. These findings underscore the need for further research to understand the specific factors associated with this trend. The development of targeted interventions and evidence-based treatments for alcohol use among female individuals becomes imperative in effectively addressing the increasing rates of alcohol-related deaths.
