Alcohol deaths in the United States have more than doubled over the past two decades, pointing to a devastating health emergency spurred on by the social and economic crisis, a new study finds. The greatest increases were among women and people middle-aged and older. Across racial and ethnic groups, non-Hispanic American Indians/Alaska Natives (NH AIAN) had the highest alcohol-related death rates in 2017.
The annual death toll from alcohol abuse has outpaced even deaths from opioids, which stood at 70,237 in 2017, according to the US Centers for Disease Control and Prevention. Only cigarettes are deadlier than alcohol, with smoking-related illnesses accounting for more than 480,000 deaths each year.
Based on data from the National Institutes of Health’s (NIH) National Center for Health Statistics, the study was published Wednesday in the journal Alcoholism: Clinical and Experimental Research. Researchers looked at death certificates from 1999 through 2017, as well as using alcohol-attributable fractions (AAFs), which specify the proportion of deaths from various causes that likely involved alcohol, based on previous research.
This data showed that deaths from alcohol rose from 35,914 in 1999 to 72,558 in 2017. Nearly 1 million (944,880) Americans died from alcohol-related causes during this period.
According to the study, 70.1 percent of the US population ages 18 and older, about 173.3 million people, consumed alcohol in 2017. This averages out to approximately 3.6 gallons of pure alcohol per drinker annually, or about 2.1 standard US drinks per day. Consumption rates for heavy drinkers are much higher.
“Alcohol is not a benign substance and there are many ways it can contribute to mortality,” said the NIH’s National Institute on Alcohol Abuse and Alcoholism (NIAAA) Director Dr. George F. Koob. “The current findings suggest that alcohol-related deaths involving injuries, overdoses, and chronic diseases are increasing across a wide swath of the population. The report is a wakeup call to the growing threat alcohol poses to public health.”
Counted in the deaths are those due to liver disease and other alcohol-related illnesses, as well as accidents such as falls and car crashes. The increase in alcohol-related deaths is consistent with reports of increases in alcohol-involved emergency department (ED) visits and hospitalizations during the period studied.
Between 2006 and 2014, rates of ED visits involving alcohol increased 47.3 percent among persons aged 12 and older, and the number of these visits increased from 3,080,214 to 4,976,136.
Chronic causes were responsible for the majority of alcohol-related deaths, 86.5 percent, including liver and cardiovascular disease, certain cancers, and other conditions. Acute causes, such as falls and accidents, were responsible for 14.6 percent of these deaths.
In 2017, alcohol played a role in 2.6 percent of all deaths in the US, according to the study. Researchers say this figure is likely an underestimation, as alcohol is underreported as a cause of death in many cases. For example, alcohol was only listed as a contributing factor in one of six motor vehicle accidents, although the proportion is known to be considerably higher.
The increase in alcohol deaths—along with other “deaths of despair,” including from opioids and suicides—has contributed to a decrease in life expectancy in the US, which fell each year from 2015 to 2017, a streak unprecedented in modern times.
The increase in alcohol deaths also follows the 2008 financial crash and Great Recession, which plunged millions of working-class families into a dire economic situation and social distress. A study last year found that rising healthcare costs, along with lack of access to medical care, were a driving force in these “deaths of despair.”
The overall prevalence of drinking and binge drinking was largest for people age 50 and older, relative to younger age groups. Despite a faster increase in alcohol-related deaths among younger adults aged 25 to 34, the overall rates of alcohol-related deaths are more than four times higher among middle-aged and older adults, aged 45 to 74.
While long-term heavy drinking can be pointed to as the driving factor in alcohol-related deaths in seniors, social factors cannot be discounted. These include the financial strain of retirement and the axing of pensions, as well as the social isolation created by the lack of a social safety net for older Americans, who are often left isolated.
Medicare, the healthcare program relied upon by the vast majority of retirees, only covers a portion of medical expenses, placing treatment for substance abuse beyond the reach of many. Another factor is the disjointed nature of the US healthcare system, in which little time is allotted by healthcare professionals for treating mental health issues.
One of the most critical findings of the study is the increase in women’s alcohol consumption and alcohol-related death rates. While the overall prevalence of drinking and binge drinking did not change for men between 2000 and 2016, there was a 10.1 percent increase in drinking and a 23.3 percent increase in binge drinking among women over these years.
While men accounted for 76.4 percent of alcohol-related deaths over the past two decades, a greater increase was observed among women—a 135.8 percent increase in numbers compared to a 92.9 percent increase for men. From 1999 to 2017, alcohol-related deaths numbered 721,587 for men and 223,293 for women, as the ratio of male to female deaths fell from 3.7:1 in 1999 to 3.0:1 in 2017. This can be traced to the increase in alcohol consumption by women during this period.
Women are also dying of alcohol-related causes at younger ages. In 1999, the highest rate of deaths for women was among ages 65 to 74, followed by ages 55 to 64. However, in 2017 this had shifted to women ages 55 to 64 having the highest death rates, followed by ages 45 to 54.
While non-Hispanic black males and females and Hispanic males saw an initial decline and then a leveling off of death rates from 1999 to 2011, this was followed by increases in alcohol-related mortality for these groups. The researchers say evidence suggests that alcohol consumption and binge drinking are increasing more among non-Hispanic blacks and Hispanics than among non-Hispanic whites.
In 2017, death certificates recorded 10,596 deaths due to overdoses from a combination of alcohol and drugs and another 2,358 deaths from alcohol alone. As alcohol causes respiratory depression on its own, the risk of acute respiratory failure increases when alcohol is combined with other drugs with the same effect, such as opioids and benzodiazepines.
This shows that the pharmaceutical industries’ flooding of communities with opioids—particularly those affected by plant and mine closures and economic devastation—has intersected with the abuse of alcohol to deadly effect. Blame also rests with the alcoholic beverage industry, which is dominated by a small number of conglomerates that promote their products through pervasive advertisements while reaping billions of dollars in profits, with scant attention paid to the potential harms to public health.
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[28 November 2019]