Alcohol-related mortality rates in the U.S. have risen since 2000, though how trends vary across socio-economic status is unclear. This analysis combines data from vital statistics and the National Health Interview Survey (NHIS) to estimate alcohol-related mortality rates at four levels of educational attainment (less than high school, high school/GED, some college/associate’s degree, 4-year degree, or more) over the period 2000–2017. The analysis includes a comprehensive set of 48 alcohol-related causes of death, including causes which are indirectly influenced by alcohol use. I consider period and cohort patterns in inequality using the relative index of inequality (RII). Results indicate that alcohol-related mortality rates increased over the study period, at all levels of educational attainment. Relative increases were larger for females than males at nearly all ages and levels of educational attainment, and were largest among 45–59-year-old women. Male and female members of the 1950–1959 birth cohort exhibited elevated rates of alcohol-related mortality relative to neighboring cohorts. Despite widespread increases in alcohol-related mortality, educational inequalities present at the beginning of the analysis persisted and exceeded those in all-cause mortality. Disparities were typically greatest among younger adults aged 30–44, though inequality in this age group declined over time. Inequality increased among females aged 60–74, as well as among males aged 45–74. While interventions targeting these groups may reduce educational disparities, care should also be taken to stem the increasing prevalence of alcohol-related deaths at all levels of educational attainment.
This is a preview of subscription content, access via your institution.
Buy single article
Instant access to the full article PDF.
Price includes VAT (USA)
Tax calculation will be finalised during checkout.
Alcohol-Related Disease Impact (ARDI) database. cdc.gov/ardi.
Anonymous. (2017). Details omitted for blind review.
Baan, R., Straif, K., Grosse, Y., Secretan, B., El Ghissassi, F., Bouvard, V., et al. (2007). Carcinogenicity of alcoholic beverages. Lancet Oncology,8(4), 292–293.
Bell, S., Daskalopoulou, M., Rapsomaniki, E., George, J., Britton, A., Bobak, M., et al. (2017). Association between clinically recorded alcohol consumption and initial presentation of 12 cardiovascular diseases: Population based cohort study using linked health records. British Medical Journal,356, j909.
Blewett, L., Rivera Drew, J. A., Griffin, R., King, M. L., & Williams, K. C. W. (2016). IPUMS Health Surveys: National Health Interview Survey, Version 6.2. Minneapolis: University of Minnesota. https://doi.org/10.18128/D070.V6.2.
Breslow, R. A., & Graubard, B. I. (2008). Prospective study of alcohol consumption in the United States: Quantity, frequency, and cause-specific mortality. Alcoholism, Clinical and Experimental Research,32(3), 513–521.
Breslow, R. A., Guenther, P. M., Juan, W., & Graubard, B. I. (2010). Alcoholic beverage consumption, nutrient intakes, and diet quality in the U.S. adult population, 1999-2006. Journal of the American Dietetic Association,110(4), 551–562.
Caldwell, T. M., Rodgers, B., Clark, C., Jefferis, B. J. M. H., Stansfeld, S. A., & Power, C. (2008). Lifecourse socioeconomic predictors of midlife drinking patterns, problems and abstention: Findings from the 1958 British birth cohort study. Drug and Alcohol Dependence,95(3), 269–278.
Case, A., & Deaton, A. (2015). Rising morbidity and mortality in midlife among white non-Hispanic Americans in the 21st century. Proceedings of the National academy of Sciences of the United States of America,112(49), 15078–15083.
Case, A., & Deaton, A. (2017). Mortality and morbidity in the 21st century. Brookings Papers on Economic Activity,2017, 397–476.
Centers for Disease Control and Prevention (CDC). (2012). Vital signs: Binge drinking prevalence, frequency, and intensity among adults: United States, 2010. Morbidity and Mortality Weekly Report,61(1), 14–19.
Grant, B. F., Chou, S. P., Saha, T. D., Pickering, R. P., Kerridge, B. T., Ruan, W. J., et al. (2017). Prevalence of 12-month alcohol use, high-risk drinking, and DSM-IV Alcohol Use Disorder in the United States, 2001-2002 to 2012-2013 results from the National Epidemiologic Survey on Alcohol and Related Conditions. JAMA Psychiatry,74(9), 911–923.
Hendi, A. S. (2017). Trends in education-specific life expectancy, data quality, and shifting education distributions: A note on recent research. Demography,54(3), 1203–1213.
Herttua, K., Mäkelä, P., & Martikainen, P. (2011). An evaluation of the impact of a large reduction in alcohol prices on alcohol-related and all-cause mortality: Time series analysis of a population-based natural experiment. International Journal of Epidemiology,40(2), 441–454.
Herttua, K., Ostergren, O., Lundberg, O., & Martikainen, P. (2017). Influence of affordability of alcohol on educational disparities in alcohol-related mortality in Finland and Sweden: A time series analysis. Journal of Epidemiology and Community Health,71(12), 1168–1176.
Ho, J. Y. (2017). The contribution of drug overdose to educational gradients in life expectancy in the United States, 1992-2011. Demography,54(3), 1175–1202.
Jamal, A., Homa, D. M., O’Connor, E., Babb, S. D., Caraballo, R. S., Singh, T., et al. (2015). Current cigarette smoking among adults: United States 2005-2014. Centers for Disease Control and Prevention Morbidity and Mortality Weekly Report,64(44), 1233–1240.
Kanny, D., Naimi, T. S., Liu, Y., Lu, H., & Brewer, R. D. (2018). Annual total binge drinks consumed by U.S. adults, 2015. American Journal of Preventive Medicine,54(4), 486–496.
Keyes, K. M., Hatzenbuehler, M. L., McLaughlin, K. A., Link, B., Olfson, M., Grant, B. F., et al. (2010). Stigma and treatment for alcohol disorders in the United States. American Journal of Epidemiology,172(12), 1364–1372.
Kuh, D., Ben-Shlomo, Y., Lynch, J., Hallqvist, J., & Power, C. (2003). Life course epidemiology. Journal of Epidemiology and Community Health,57(10), 778–783.
Lieber, C. (2003). Relationships between nutrition, alcohol use, and liver disease. Alcohol Research & Health,27(3), 220–231.
Lui, C. K., Kerr, W. C., Mulia, N., & Ye, Y. (2018). Educational differences in alcohol consumption and heavy drinking: An age-period-cohort perspective. Drug and Alcohol Dependence,186, 36–43.
Mackenbach, J. P., Kulhanova, I., Bopp, M., Borrell, C., Deboosere, P., Kovacs, K., et al. (2015). Inequalities in alcohol-related mortality in 17 European countries: A retrospective analysis of mortality registers. PLOS Medicine,12(12), e1001909.
Mackenbach, J., & Kunst, A. (1997). Measuring the magnitude of socio-economic inequalities in health: An overview of available measures illustrated with two examples from Europe. Social Science and Medicine,44(6), 757–771.
Mäkelä, P., Herttua, K., & Martikainen, P. (2015). The socioeconomic differences in alcohol-related harm and the effects of alcohol prices on them: A summary of evidence from Finland. Alcohol and Alcoholism,50(6), 661–669.
Mäkelä, P., & Paljärvi, T. (2008). Do consequences of a given pattern of drinking vary by socioeconomic status? A mortality and hospitalisation follow-up for alcohol-related causes of the Finnish drinking habits surveys. Journal of Epidemiology and Community Health,62(8), 728–733.
Mehta, N. K., House, J. S., & Elliott, M. R. (2015). Dynamics of health behaviours and socioeconomic differences in mortality in the USA. Journal of Epidemiology and Community Health,69(5), 416–422.
Miniño, A.M., Arias, E., Kochanek, K.D., Murphy, S.L., Smith, B.L. (2002). Deaths: Final Data for 2000. National vital statistics reports (vol 50 no 15). Hyattsville, Maryland: National Center for Health Statistics.
Mossakowski, K. N. (2008). Is the duration of poverty and unemployment a risk factor for heavy drinking? Social Science and Medicine,67(6), 947–955.
National Bureau of Economic Research. (2019). Vital Statistics NCHS’ Multiple Cause of Death Data, 1959-2017. Cambridge, MA. Retrieved from https://www.nber.org/data/vital-statistics-mortality-data-multiple-cause-of-death.html.
Probst, C., Roerecke, M., Behrendt, S., & Rehm, J. (2014). Socioeconomic differences in alcohol-attributable mortality compared with all-cause mortality: A systematic review and meta-analysis. International Journal of Epidemiology,43(4), 1314–1327.
Rehm, J., Baliunas, D., Borges, G. L. G., Graham, K., Irving, H., Kehoe, T., et al. (2010). The relation between different dimensions of alcohol consumption and burden of disease: An overview. Addiction,105(5), 817–843.
Roerecke, M., & Rehm, J. (2010). Irregular heavy drinking occasions and risk of ischemic heart disease: A systematic review and meta-analysis. American Journal of Epidemiology,171(6), 633–644.
Rogers, R. G., Boardman, J. D., Pendergast, P. M., & Lawrence, E. M. (2015). Drinking problems and mortality risk in the United States. Drug and Alcohol Dependence,151, 38–46.
Rostron, B. L., Boies, J. L., & Arias, E. (2010). Education reporting and classification on death certificates in the United States. Vital and Health Statistics,151(2), 1–21.
Schalick, L., Hadden, W., Pamuk, E., Navarro, V., & Pappas, G. (2000). The widening gap in death rates among income groups in the United States from 1967 to 1986. International Journal of Health Services,30(1), 13–26.
Stahre, M., Roeber, J., Kanny, D., Brewer, R. D., & Zhang, X. (2014). Contribution of excessive alcohol consumption to deaths and years of potential life lost in the United States. Preventing Chronic Disease,11, 130293.
Taylor, B., & Rehm, J. (2006). When risk factors combine: The interaction between alcohol and smoking for aero-digestive cancer, coronary heart disease, and traffic and fire injury. Addictive Behaviors,31(9), 1522–1535.
Virtanen, S., Kaprio, J., Viken, R., Rose, R., & Latvala, A. (2018). Birth cohort effects on the quantity and heritability of alcohol consumption in adulthood: A Finnish longitudinal twin study. Behavior Genetics,48(6), 518–519.
Watzl, B., & Watson, R. (1992). Role of alcohol-abuse in nutritional immunosuppression. Journal of Nutrition,122(3), 733–737.
White, A. M., Slater, M. E., Ng, G., Hingson, R., & Breslow, R. (2018). Trends in alcohol-related emergency department visits in the United States: Results from the nationwide emergency department sample, 2006 to 2014. Alcoholism, Clinical and Experimental Research,42(2), 352–359.
Xu, J.Q., Murphy, S.L., Kochanek, K.D., Bastian, B., Arias, E. (2018). Deaths: Final data for 2016. National Vital Statistics Reports (vol 67 no 5). Hyattsville, MD: National Center for Health Statistics.
Zaridze, D., Brennan, P., Boreham, J., Boroda, A., Karpov, R., Lazarev, A., et al. (2009). Alcohol and cause-specific mortality in Russia: A retrospective case-control study of 48,557 adult deaths. Lancet,373(9682), 2201–2214.
Zhao, J., Zhu, Y., Wang, P. P., West, R., Buehler, S., Sun, Z., et al. (2012). Interaction between alcohol drinking and obesity in relation to colorectal cancer risk: A case-control study in Newfoundland and Labrador. Canada. BMC Public Health,12(1), 94.
I am grateful to Samuel Preston, Irma Elo, Michel Guillot, Jessica Ho, and three anonymous reviewers for invaluable feedback on this paper. This research received support from the Population Research Training Grant (NIH T32 HD007242) awarded to the Population Studies Center at the University of Pennsylvania by the National Institutes of Health’s Eunice Kennedy Shriver National Institute of Child Health and Human Development.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Electronic supplementary material
Below is the link to the electronic supplementary material.
About this article
Cite this article
Vierboom, Y.C. Trends in Alcohol-Related Mortality by Educational Attainment in the U.S., 2000–2017. Popul Res Policy Rev 39, 77–97 (2020). https://doi.org/10.1007/s11113-019-09527-0
- Socio-economic status
- United States