Tag: alcohol deaths

09/10/24

The Death Toll from Alcohol

The number of celebrities who died from substance abuse are legion, including: Elvis Presley, Hank Williams, Marilyn Monroe, and Jackie Wilson. There’s even a so-called “27 club” of entertainers who died at the age of 27 from substance abuse: Janice Joplin, Jimi Hendrix and Jim Morrison are members. But Curt Cobain is not a member, since he died from a heroin overdose and a self-inflicted gunshot wound at 28. And in October 2023, there was Matthew Perry’s accidental death from ketamine. But celebrities have also overdosed and died from alcohol. To name just a few, there’s: Billie Holiday, Amy Winehouse, David Cassidy and the British actors Oliver Reed and Richard Burton.

The World Health Organization (WHO) recently reported in their “Global status report on alcohol and health treatment of substance use disorders” that 2.6 million deaths were attributable to alcohol consumption, accounting for 4.7% of all deaths. Of these, the WHO reported 1.6 million deaths were from noncommunicable diseases such as liver diseases, heart diseases cancers, and others. There were 700,000 deaths from injuries and another 300,000 from communicable diseases. Another estimated 400 million (7% of the world’s population aged 15 years and over) live with alcohol use disorders. The highest levels of consumption were seen in the WHO European Region (9.2 liters) and the Region of Americas (7.5 liters).

The level of alcohol consumption per capita among drinkers amounts on average to 27 grams of pure alcohol per day, roughly equivalent to two glasses of wine, two bottles of beer (33cl) or two servings of spirits (4cl). This level and frequency of drinking is associated with increased risks of numerous health conditions and associated mortality and disability.

In 2019, 38% of current drinkers had engaged in heavy episodic drinking, defined as consuming at least 60g of pure alcohol on one or more occasions in the preceding month – roughly equivalent to 4 or 5 glasses of wine, bottles of beer or servings of spirits. Continuous heavy drinking was highly prevalent among men.

Globally, 23.5% of all 15–19 year-olds were current drinkers. Rates of current drinking were highest among 15–19-year-olds in the European region (45.9%) followed by the Americas (43.9%).

There were an estimated 474,000 deaths from cardiovascular diseases in 2019 from alcohol consumption. And alcohol consumption increases the risk for several cancers, including breast, liver, head and neck, oesophageal and colorectal. “In 2019, 4.4% of cancers diagnosed globally and 401,000 cancer deaths were attributed to alcohol consumption.” There were 298,000 deaths from alcohol-related road crashes in 2019—156,000 caused by someone else’s drinking. Other injuries include falls, drowning, burns, sexual assault, intimate partner violence and suicide.

The WHO said there was no form of alcohol consumption that is risk-free. “The level of risk depends on several factors, including the amount consumed, frequency of drinking, the health status of the individual, age, sex, and other personal characteristics, as well as the context in which alcohol consumption occurs.”

Alcohol Deaths in the U.S.

Statistics on deaths in the U.S. from excessive alcohol use reported by NIH and the CDC aren’t a reason for optimism, as this article’s CDC graphic indicates. The NIH estimated there were more than 178,000 deaths (120,00 males and 59,000 females) attributable to excessive alcohol use in 2020-2021. An analysis of death certificates from 2019 to 2020 indicated deaths involving alcohol rose 25.5%, from 79,000 to 99,000. In 2022, alcohol-impaired driving fatalities accounted for 32% of overall driving fatalities, 13,524 deaths. Citing CDC estimates, 21% of all deaths by suicide have a blood alcohol level at or above .1%.

The CDC indicated the 178,000 deaths due to excessive alcohol use in 2020-2021 was a 29% increase over 2016-2017. “This shortened the lives of those who died by an average of 24 years.” One-third of these deaths were from binge drinking or drinking too much on one occasion. Deaths increased among all age groups. They usually involved adults 35 and older, but also included around 4,000 under the age of 21.

In a CDC Morbidity and Mortality Weekly Report (MMWR), Esser et al said 100% alcohol-attributable causes of death have increased over the past 20 years in the U.S. They noted the onset of the COVID-19 pandemic as a specific causative factor. Also see “The Unseen Surge of Alcohol Use.” Deaths among males from excessive alcohol use increased 26.8% from 2016-2017 to 2020-2021 and 34.7% among females.

From 2016–2017 to 2020–2021, the average annual number of U.S. deaths from excessive alcohol use increased by more than 40,000 (29%), from approximately 138,000 per year (2016–2017) to 178,000 per year (2020–2021). This increase translates to an average of approximately 488 deaths each day from excessive drinking during 2020–2021. From 2016–2017 to 2020–2021, the average annual number of deaths from excessive alcohol use increased by more than 25,000 among males and more than 15,000 among females; however, the percentage increase in the number of deaths during this time was larger for females (approximately 35% increase) than for males (approximately 27%). These findings are consistent with another recent study that found a larger increase in fully alcohol-attributable death rates among females compared with males.

Increases in deaths from excessive alcohol use during the study period occurred among all age groups. A recent study found that one in eight total deaths among U.S. adults aged 20–64 years during 2015–2019 resulted from excessive alcohol use. Because of the increases in these deaths during 2020–2021, including among adults in the same age group, excessive alcohol use could account for an even higher proportion of total deaths during that 2-year period. In addition, data from Monitoring the Future, an ongoing study of the behaviors, attitudes, and values of U.S. residents from adolescence through adulthood, showed that the prevalence of binge drinking among adults aged 35–50 years was higher in 2022 than in any other year during the past decade; this increase could contribute to future increases in alcohol-attributable deaths. In this study, fewer than one third of deaths from excessive alcohol use were from fully alcohol-attributable causes, highlighting the importance of also assessing partially alcohol-attributable causes to better understand the harms from excessive drinking, including binge drinking.

The increases in alcohol-related deaths have several contributing factors. “These include the availability of alcohol, increases in people experiencing mental health conditions, and challenges in accessing health care.” Esser et al said during the peak of the COVID-19 pandemic in 2020-2021, places that sold alcohol were considered essential businesses in many states; and remained open during lockdowns. There were also delays in seeking medical attention, including avoiding emergency departments for alcohol-related conditions. Stress, loneliness, and social isolation may have also contributed to the increase of deaths from excessive alcohol use during the COVID-19 pandemic.

Entering the 27 Club

Amy Winehouse’s hit song, “Rehab,” was on her second and final studio album Back to Black (2006). It won five Grammys, including Record of the Year, Song of the Year, and Best Female Pop Vocal Performance. In Rehab’s lyrics, Amy said:

I don’t ever want to drink again. I just, I just need a friend. I’m not going to spend ten weeks; have everyone think I’m on the mend. It’s not just my pride, it’s just til these tears have dried. They tried to make me go to rehab, but I said no, no, no.

On July 23, 2011, Amy was found unresponsive by her bodyguard in her home at Camden Square. She was pronounced dead at the scene. Police found one small and two large bottles of vodka in her room. She was 27 and became another member of the 27 Club. She should have gone to rehab.

11/9/21

The Unseen Surge of Alcohol Use

© bryndin | 123rf.com

Although the increase in overdose deaths preceded the COVID pandemic, the pandemic seems to have accelerated the trend. In December of 2020, the CDC reported that drug overdose deaths in the U.S. rose 29.4% that year, mostly from illicitly manufactured fentanyl. Overdose deaths involving psychostimulants increased 10 times from 2009 to 2019. This increase was a mixture of opioids and psychostimulants as well as psychostimulants alone. But all the attention on these two drug classes seems to have overlooked the unseen surge of COVID-related increases with another drug—alcohol.

Using death certificate data from the National Center for Health Statistics, White et al found that almost 1 million people died from alcohol-related causes between 1999 and 2017. The number of death certificates mentioning alcohol more than doubled during that time frame. The Director of the National Institute on Alcohol Abuse and Alcoholism (NIAAA), George Koob, said:

Alcohol is not a benign substance and there are many ways it can contribute to mortality. 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.

The researchers found that nearly half of alcohol-related deaths were from liver disease (31%) or overdoses on alcohol alone or with other drugs (18%). By the end of the study, alcohol-related deaths were increasing among people in almost every age, racial and ethnic group. Death rates increased for women (85%) more than men (35%). Women also appeared to be at a greater risk for several alcohol-related consequences than men—including cardio-vascular disease, liver disease, alcohol use disorder. Dr. Koob said:

Taken together, the findings of this study and others suggests that alcohol-related harms are increasing at multiple levels – from ED visits and hospitalizations to deaths. We know that the contribution of alcohol often fails to make it onto death certificates. Better surveillance of alcohol involvement in mortality is essential in order to better understand and address the impact of alcohol on public health.

The researchers said alcohol-related deaths were highest among males, individuals between 45 and 74 years of age, and non-Hispanic American Indians or Alaska Natives. Rates increased for all age-groups except 16 to 20 and 75 and over. The largest increase was among non-Hispanic White females. These findings confirm the increasing burden of alcohol on public health.

On his blog, William White observed how the alarm over recent drug surges with opioids and methamphetamines could be obscuring surges in alcohol consumption and its related consequences. In addition to the White et al study, William White also referred to Sherk et al, whose researchers found that even light or moderate alcohol consumption increased the risk for a number of health consequences, including cancer, heart disease and traumatic injuries. More than one quarter (27%) of alcohol-related hospital stays were experienced by individuals who drank within the weekly guidelines.

The low-risk drinking guidelines for men were no more than 14 drinks per week and no more than 4 drinks per day. Low risk guidelines for women were no more than 7 drinks per week and no more than 3 drinks per day. Sherk et al concluded drinkers who followed weekly low-risk drinking guidelines were not immune from harm. They suggested guidelines of one drink per day for both sexes. The researchers clearly demonstrated that alcohol abuse and the related consequences were increasing before the COVID pandemic.

Alcohol Abuse and COVID

As stay-at-home orders began in some US states to lessen COVID-19 transmission in March of 2020, Nielsen reported a 54% increase in national sales of alcohol for the week ending Mach 21, 2020. The World Health Organization warned that alcohol use could potentially worsen health vulnerability, risk-taking behaviors, mental health issues and violence. The WHO suggested existing rules and regulations to protect health and reduce the harm caused by alcohol, such as restricting access, should be reinforced during the COVID-19 pandemic. “Any relaxation of regulations or their reinforcement should be avoided.”

Pollard, Tucker and Green looked at “Changes in Adult Alcohol Use and Consequences During the COVID-19 Pandemic in the US.” The data were collected using the RAND Corporation American Life Panel (ALP), a nationally representative, probability-sample panel of 6,000 participants. A sample of 2,615 ALP members ages, 30-to-80, were invited to participate in the baseline survey.

Comparisons before and during the COVID-19 pandemic were made on the number of days participants reported any alcohol use and heavy drinking, and the average number of drinks consumed over the previous 30 days. Heavy drinking was defined as 5 or more drinks for men and 4 or more drinks for women within a couple of hours. Adverse consequences were assessed by the 15-item Short Inventory of Problems associated with alcohol use in the previous 3 months. Comparisons were made overall, and across self-reported sex, age, and race/ethnicity.

These data provide evidence of changes in alcohol use and associated consequences during the COVID-19 pandemic. In addition to a range of negative physical health associations, excessive alcohol use may lead to or worsen existing mental health problems, such as anxiety or depression, which may themselves be increasing during COVID-19. The population level changes for women, younger, and non-Hispanic White individuals highlight that health systems may need to educate consumers through print or online media about increased alcohol use during the pandemic and identify factors associated with susceptibility and resilience to the impacts of COVID-19.

It does seem that concern with overdoses from opioids and methamphetamine in the midst of COVID overshadowed the growing problem with increasing alcohol consumption and its related consequences during the pandemic. William White observed that alcohol use is historically pervasive in the U.S. and “so infused into the cultural water in which we all swim that we fail to see it. That blindness has exacted, and continues to exact, an enormous toll on individuals, families, and communities.” The findings of the above discussed research studies reinforce the need for continued efforts with public and professional alcohol-related education, alcohol treatment resources, screening for alcohol problems and recovery support for individuals and families effected by alcohol use disorders. We cannot let concerns with the pandemic or opioid epidemic draw our attention away from the growing problem with alcohol-related deaths.