Excessive Alcohol Use Contributes to 93,000 US Deaths Annually

Batya Swift Yasgur, MA, LSW

July 31, 2020

Excessive alcohol use is responsible for more than 93,000 deaths annually in the United States. On average, 29 years of life are lost per death, a new report shows.

The majority of these deaths involved men, and roughly 80% involved adults aged 35 years and older.

The study, which was published by the Centers for Disease Control and Prevention (CDC) in Morbidity and Mortality Weekly Report, used data from the Alcohol-Related Disease Impact (ARDI) application to estimate the average annual deaths, as well as the years of potential life lost (YPLL), between 2011 and 2015 in the nation and the states.

Included were deaths of the person who consumed the alcohol, as well as deaths that resulted from another individual's alcohol use, such as passengers killed in motor vehicle accidents or a child's death caused by a pregnant mother's drinking.

"Little progress has been made in preventing deaths caused by excessive drinking," Marissa B. Esser, PhD, Bureau of Immunization, New York City Department of Health and Mental Hygiene, and colleagues write.

In fact, "the average estimates of alcohol-attributable deaths and YPLL in this report are slightly higher than estimates for 2006–2010, and the age-adjusted alcohol-attributable death rates are similar, suggesting that excessive drinking remains a leading preventable cause of death and disability," they add.

The report was published online July 31.

Binge Drinking

Costs associated with excessive alcohol use, including loss in workplace productivity, healthcare expenditures, and criminal justice, were $249 billion in 2010, the investigators note.

The CDC investigators analyzed the prevalence of alcohol-attributable deaths from 2011 to 2015. Annually, there were on average 93,296 alcohol-attributable deaths, or 255 deaths per day.

Of these, 54.7% of deaths (n = 51,078) were caused by chronic alcohol-related conditions ― most prominently, alcohol-attributable liver disease (n = 18,164).

The other 45.2% of deaths (n = 42,218) were caused by acute conditions. Poisonings involving another substance, such as drug overdose, were the leading cause of deaths overall (n = 11,839) and among women (n = 4315). Suicide associated with excessive alcohol use was the leading cause of death among men (n = 7711).

Among the alcohol-attributable deaths:

  • 71.3% (n = 66,519) involved males

  • 56.1% (n = 52,361) involved adults aged 35 – 64 years

  • 26.5% (n = 24,766) involved adults 65 years or older

  • 14.9% (n = 13,910) involved adults aged 24 – 34 years

Each year, there was an average of 2.7 million YPLL (29 years of life lost per death). Of these:

  • 41.1% (1.1 million) were caused by chronic conditions

  • 58.8% (1.6 million) were caused by acute conditions

  • 70.8% (1.9 million) involved males

Some conditions, such as alcoholic liver cirrhosis, were classified by ARDI as being wholly (100%) attributable to alcohol, whereas others, such as hypertension, were regarded as being partially attributable.

Cancers ― particularly liver, oral cavity/pharyngeal, and colorectal cancers ― were among the leading chronic causes of alcohol-attributable deaths and YPLL, as were cardiovascular conditions, especially coronary heart disease and hypertension.

"Conditions wholly attributable to alcohol accounted for 29,068 (31.2%) of all alcohol-attributable deaths and 762,241 (28.4%) of all YPLL," the investigators write.

"Approximately one-half of alcohol-attributable deaths were caused by chronic conditions, but acute alcohol-attributable deaths, all of which were caused by binge drinking, accounted for the majority of the YPLL from excessive drinking," they add.

State-to-State Variations

There were important differences in the numbers of alcohol-attributable deaths and YPLL across states. The fewest were in Vermont, and the most were in California.

In Vermont, there were 233 alcohol-attributable deaths and 5074 YPLL. In California, there were 10,811 alcohol-attributable deaths and 299,336 YPLL.

There was wide variation between age-adjusted alcohol-attributable death rates among the 40 states for which there were reliable estimates. The lowest was in New Jersey and New York (20.3 per 100,000), and the highest was in New Mexico (52.3 per 100,000).

New York also had the lowest YPLL per 100,000 (613.8); New Mexico had the highest (1651.7).

"Age-adjusted alcohol-attributable deaths varied approximately twofold across states, but deaths caused by excessive drinking were common across the country," the authors write.

These differences "might be partially explained by varying patterns of excessive alcohol use, particularly binge drinking, which is affected by state-level alcohol pricing and availability strategies and differential access to medical care," they note.

Population-Based Strategies

The investigators list several limitations in their report, including the fact that prevalence was ascertained through self-reported data, "which substantially underestimates alcohol consumption." Moreover, the estimates are "conservative," because former drinkers who might have died from alcohol-related conditions were not included.

Another limitation was that estimates were not available for several conditions, such as tuberculosis, HIV, and AIDs, the researchers note.

In addition, "the alcohol-attributable deaths and YPLL are based on alcohol-related conditions that were listed as the underlying (ie, primary) cause of death, and not as a multiple cause of death, yielding conservative estimates," they write.

Despite these limitations, the authors point to important implications in their findings.

They encourage "the implementation of effective population-based strategies for preventing excessive drinking, such as those recommended by the Community Preventive Services Task Force."

These recommendations include increasing alcohol taxes and regulating the number and concentration of alcohol outlets.

These strategies can complement other population-based prevention strategies that focus on health risk behaviors that are often associated with excessive alcohol consumption, including safer prescribing practices to reduce opioid misuse and overdoses and interventions to reduce alcohol-impaired driving, the authors write.

Besser has reported no relevant financial relationships. The other authors' disclosures are listed in the original article.

Morb Mortal Wkly Rep. Published online July 31, 2020. Full text

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