During 2006–2010, excessive alcohol use resulted in a median annual age-adjusted AAD rate of 28.5 per 100,000 population and a median YPLL rate of 823 per 100,000 in the 11 states studied. Approximately two out of three deaths and four out of five YPLL were among working-aged adults, and more than two thirds of AAD and YPLL involved males. Although the majority of AAD involved non-Hispanic whites, the median AAD rate for AI/AN (60.6 per 100,000) was twice as high as the AAD rate for any other racial or ethnic group. These findings are consistent with other published estimates on the distribution of AAD and YPLL by sex, disparities by race/ethnicity within states, and differences in AI/AN rates among states.
The findings in this report highlight the ongoing public health impact of excessive drinking in the United States, as well as the geographic and demographic disparities in AAD and YPLL. Differences in age-adjusted rates of AAD and YPLL among states probably reflect differences in the prevalence of excessive drinking, which is affected by various factors, including state and local laws governing the price, availability, and marketing of alcoholic beverages. These death rates also might reflect the influence of other factors (e.g., rurality and access to trauma care) that could affect the risk for death from alcohol-attributable conditions. The high rates of AAD and YPLL among working-age adults further highlight the impact of excessive alcohol use throughout a person's lifespan, and were a major contributor to alcohol-attributable productivity losses from premature mortality that, together with lost wages, were responsible for 72% of the estimated $223.5 billion in economic costs in 2006. The AAD and YPLL rates were lower among the 0–19 years age group because this age group had fewer AAD compared with other age groups.
The findings in this report are subject to at least seven limitations. First, ARDI exclusively uses the underlying cause of death and does not consider contributing causes that might be alcohol-related. Second, ARDI does not include AAD estimates for several causes (e.g., tuberculosis) for which excessive alcohol use is believed to be an important risk factor. Third, the alcohol data used to calculate AAF estimates were based on self-reports and might underestimate the actual prevalence of excessive alcohol use. Fourth, state estimates calculated in this study might be different than those available in the ARDI application. Fifth, national AAF data were used, even though studies suggest that there are important state differences in AAF for some causes of alcohol-attributable deaths. Sixth, AAD and YPLL rates could not be calculated for some age and race/ethnicity categories because of the small number of AAD in some of these groups. Finally, some AI/AN might have been misclassified by race on death certificates, which could have resulted in an underestimate of the number of AI/AN deaths and YPLL in states.
The Community Preventive Services Task Force has recommended several population-level, evidence-based strategies to reduce excessive drinking and related harms, including increasing the price of alcohol, limiting alcohol outlet density, and holding alcohol retailers liable for harms related to the sale of alcoholic beverages to minors and intoxicated patrons (dram shop liability). Routine monitoring of alcohol-attributable health outcomes, including deaths and YPLL, in states could support the planning and implementation of evidence-based prevention strategies to reduce excessive drinking and related harms.
Morbidity and Mortality Weekly Report. 2014;63(10):213-216. © 2014 Centers for Disease Control and Prevention (CDC)