Alcohol-Related Deaths Rise in U.S. Women

Jennifer Middleton, MD, MPH
Posted on July 31, 2023

Although alcohol-related deaths remain more prevalent in the United States in men than in women, recent data from the Centers for Disease Control and Prevention (CDC) shows that this gap is narrowing. A study published last week in JAMA Network Open found “a significantly higher rate of increase in deaths among female individuals in recent years.” This trend aligns with recent studies showing an increase in alcohol use and alcohol-related harms among U.S. women in their 30s and 40s.

The JAMA Network Open study examined U.S. mortality data from a CDC national database between 1999 and 2020. The database obtained information about cause of death along with gender, race, and ethnicity from death certificates. Researchers examined this data for ICD-10 codes related to complications of alcohol use and/or acute alcohol intoxication and identified nearly 606,000 deaths due to these causes during this time period, for an average of around 30,300 deaths per year. The researchers found that “both male and female individuals experienced increasing trends in alcohol-related mortality rates, but the rate of increase was higher among female individuals than among male individuals.” Study of the data regarding race and ethnicity found that:

Non-Hispanic White individuals, non-Hispanic Black individuals, and American Indian or Alaska Native individuals showed higher recent trends among female individuals than male individuals. In contrast, Asian or Pacific Islander and Hispanic male individuals had higher trends than female individuals in the most recent time segment.

The researchers chose to exclude deaths from “unintentional injuries, homicides, and other causes of death that are only indirectly or partially associated with alcohol use"; including these indirect causes, the total mortality in the United States from alcohol has been estimated to be around 140,000 deaths per year, or approximately five times higher than this study found. And, overall, alcohol-related deaths continue to rise for both genders, with a 26% jump between 2019 and 2020.

The COVID-19 pandemic only accelerated increases in alcohol-related health concerns, as discussed by Dr. Lin in this Community Blog post from last year. Family physicians must be increasingly vigilant about screening for alcohol use disorders, especially in middle-aged and older women, a population that may not always fit our internalized stereotypes regarding problem drinking. This 2019 AFP editorial on “Identification of and Treatment for Unhealthy Alcohol Use in Primary Care Settings” recommends this evidence-based screening question, “How many times in the past year have you had five (four for women) or more drinks in a day?” Any response besides “zero” should prompt use of a formal diagnostic instrument such as AUDIT (appropriate for most adults), CARET (older adults), TWEAK (pregnant persons), or CRAFFT (adolescents). Five- to 10-minute brief interventions by clinicians have been shown to decrease hazardous alcohol use; the editorial suggests the use of this handout to guide the conversation.

This 2022 article from FPM reviews strategies for increasing office-based screening for alcohol use disorders. You can also read more in the AFP By Topic on Alcohol Use Disorders, which includes this overview of the United States Preventive Services Task Force screening recommendation for alcohol use disorders along with this 2020 AFP article on “Alcohol Use Disorder: Pharmacologic Treatment Options.”