Alcoholism

Alcohol-Related Deaths Are on the Rise

Deaths related to alcohol doubled between 1999 and 2017.

Posted Jan 14, 2020

A study in Alcoholism: Clinical and Experimental Research published last week (7 January 2020 see reference below) examined death certificates to document the significant increases in alcohol-related deaths in the last 18 years. Their findings are concerning.

Overall the number of alcohol‐related deaths doubled from 35,914 to 72,558, and the rate increased 50.9 percent from 16.9 to 25.5 per 100,000 (in people 16+ years of age). That’s a total of 944,880 people who’ve died from drinking too much. Nearly half of these deaths were from liver disease (30.7 percent) or overdoses on alcohol alone or with other drugs (17.9 percent). The deaths from alcohol-related liver disease (cirrhosis) are usually not considered newsworthy because they are usually not sudden or unexpected. That makes it no less meaningful, however, to the person as well as to family and friends.

While the rates were highest among males (see graphic), the largest increase in rates was among white females. This is consistent with the increase in drinking in women in the U.S. over the last couple of decades.

 See citation
Age-adjusted death rates by gender.
Source: See citation

And it's not just the older population of drinkers affected. Rates of chronic alcohol‐related deaths increased more for younger adults aged 25 to 34 than among the older population.

Even more disconcerting, death certificates, that these data are based on, often fail to indicate the contribution of alcohol in other areas like cardiovascular disease, cancer, or diabetes. When I was on a heart transplant team in the '80s we saw a number of potential candidates whose drinking had directly contributed to their cardiac disease that necessitated their being considered for a heart transplant. Those who died though would not usually have been given an alcohol-related diagnosis as the cause of death but cardiac failure instead. So the picture is likely even worse than the death certificate data would suggest.

How much is too much?

You may be asking yourself, how much drinking is too much? The National Institute on Alcohol Abuse and Alcoholism (NIAAA) has defined a level of drinking that the research considers “low-risk.” It is no more than three drinks on any day and no more than seven in a week for women and for men no more than four drinks per day and no more than 14 drinks per week.

People over 65 years of age have lower risk levels of drinking. For healthy men 65+, it’s the same as for women under 65, no more than three a day and seven per week. And for healthy women, the same limits apply regardless of age.

These numbers refer to standard drinks (12 ounces of 5 percent beer, 5ounces of 12 percent wine, or 1.5 ounces of 80 proof spirits).

Drinking and Medical Conditions

There are also a number of medical conditions where any drinking is risky for your health. In the past, I’ve found 50 medical conditions that are impacted by drinking. Here is an example.

When I worked on the heart transplant team at Presbyterian Hospital in Albuquerque, New Mexico, in the mid-'80s to mid-'90s I was asked to see a patient (on the transplant waiting list) in the hospital because he had been hospitalized with acutely poor cardiac output. The physicians on my team had wondered whether he’d had an anxiety attack that triggered his acute episode and landed him in the emergency room. In discussing that day with the patient (and his wife), it was clear that he had not had any emotional upset. He had, however, a single 12 oz. beer. And he started feeling poorly shortly afterward, which led to his hospitalization. Yes, a single drink can do that to a person who has impaired cardiac output. (Rest assured, that was the last drink he ever had.)

If you have a medical condition(s) I encourage you to discuss your level of drinking with your physician. And to be honest about your consumption. In my 30+ years of working with primary care physicians, I’ve found very few who would not be understanding and want to give you valid feedback.

References

White, A.M., Castle, I.P., HIngson, R., & Powell, P.A. (2020) Using Death Certificates to Explore Changes in Alcohol‐Related Mortality in the United States, 1999 to 2017. https://doi.org/10.1111/acer.14239