Are there sex-based differences in the contemporary burden and trends of alcohol-related mortality in the US?

By Vijay Kumar MalesuAug 2 2023Reviewed by Sophia Coveney

In a recent study published in JAMA Network Open, a group of researchers analyzed the trends and disparities in alcohol-related mortality in the United States (US) from 1999 to 2020, considering factors like sex, age, race, ethnicity, and geographic region.

Background

The World Health Organization (WHO) reports that even minimal alcohol consumption is harmful. Alcohol is a significant cause of preventable deaths in the US, associated with health complications, and involved in a substantial number of emergency visits and opioid-related deaths.

A higher burden is observed among men, but recent studies show a narrowing gender gap due to rising alcohol misuse and disorders among women. Biological factors may make women more vulnerable to complications.

Literature on alcohol-related mortality rates, especially during the coronavirus disease 2019 (COVID-19) pandemic, often lacks current data or focuses on non-mortality aspects.

About the study

The present study followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guideline for cross-sectional studies.

Mortality data from 1999 to 2020 was obtained from the Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research (CDC WONDER) database using the international statistical classification of diseases and related health problems, tenth revision (ICD-10) codes to identify alcohol-related deaths.

Crude and age-adjusted mortality rates (AAMR) were calculated by demographics and cause of death. Race, ethnicity, and sex information came from death certificates.

Race and ethnicity were included to investigate disparities and social determinants of health. Additionally, interactions between race, ethnicity and sex were explored to gain insights into mortality differences.

Joinpoint regression was used to assess trends over time. An initial linear model was fitted with joinpoints added to detect changes in trend. Further, the Bonferroni correction was applied to determine the optimal number of joinpoints.

A sensitivity analysis excluding 2020 data was conducted to examine pre-pandemic trends. The log-transformed AAMR was modeled as a function of the year using an uncorrelated errors model. Default options were used for the joinpoint regression analysis.

Study results

The study results revealed that from 1999 to 2020, alcohol-related causes led to the deaths of 605,948 individuals in the US. The AAMR per 100,000 persons was found to be 8.3.

Men's mortality rate was substantially higher than women's, making them 2.88 times more susceptible to losing their lives due to alcohol-related issues. This gender disparity in alcohol-related mortality remained consistent across varying subcategories like age, race and ethnicity, region of census, and cause of death.

In terms of overall alcohol-related mortality patterns in the US, rates remained steady from 1999 to 2007 but surged by 3.0% annually from 2007 to 2018. A further increase of 14.1% per year was noticed from 2018 to 2020.

On examining sex-specific trends, the trend for men was stable until 2009, after which it increased to 3.0% annually till 2018 and 12.5% from 2018 to 2020. In contrast, the trend for women grew at a slightly higher pace of 1.0% annually until 2007, then 4.3% annually till 2018, and increased to 14.7% per year from 2018 to 2020.

Upon segregating the data by sex and age, alcohol-related mortality trends were observed to be increasing among both genders across all age groups. In individuals under 60 years, men showed a higher increase rate in the recent trend than women. Conversely, in adults aged 65 years and above, women exhibited a higher annual rate of change compared to men.

Further stratification by race and ethnicity demonstrated that alcohol-related mortality increased in both genders. Among non-Hispanic Whites, non-Hispanic Blacks, and American Indian or Alaska Natives, women showed higher recent trends than men, while among Asian or Pacific Islanders and Hispanics, men had higher trends than women.

When scrutinized by census region and sex, both genders showed increased alcohol-related mortality trends, but at different rates. In the South and West, men had higher trends than women, while in the Northeast and Midwest, the reverse was true.

Sensitivity analysis of alcohol-related mortality rates from the year 1999 to 2019 disclosed distinct patterns. The rates remained fairly stable until 2005, then rose gradually to 1.7% annually until 2011. From 2011 to 2019, the rates rose sharply to 3.8% annually. When analyzed by gender, the increasing trends were noted in both men and women, but women experienced a steeper increase.