INTRODUCTION

In the United States (US), alcohol use disorder remains a major contributor to all-cause morbidity with a persistent uptrend in deaths from alcohol-induced causes.1, 2 While recent guidelines from the US Preventative Services Task Force have recommended screening for all adults in the primary care setting,3 understanding the regional disparities and associated sociodemographic factors that may impact the mortality from alcohol-induced causes can aid in prioritizing allocation of resources to at-risk subpopulations.

METHODS

Using data obtained from the National Center for Health Statistics, we performed a cross-sectional study analyzing all deaths attributable to alcohol-induced causes as defined by the Center of Disease Control by US Census region (Northeast, Midwest, South, and West) and state from 2000 through 2017.4 Age-adjusted death rates (per 100,000 persons) for overall and population-specific cohorts were calculated for each US region and state using annual data from US Census Bureau.4 The study period was divided into two periods, 2000–2009 and 2010–2017, and the relative percent change was calculated between these periods.

RESULTS

Overall, the age-adjusted mortality from alcohol-induced causes increased within all four US regions from 2000–2009 to 2010–2017, with similar rising trends in mortality from alcoholic liver disease (Table 1). The West region had the highest overall mortality from alcohol-induced causes; over a 75% higher rate compared with all other US regions. From 2000 to 2009, the South had the second highest overall mortality but was surpassed by the Midwest in 2010–2017, with similar regional patterns noted in middle-aged adults between 45 and 64 years as well as both men and women.

Table 1 Age- and Population-Specific Adjusted Death Rates (Per 100,000 Persons) Attributed to Alcohol-Induced Causes Within the 4 United States Regions from 2000 to 2017
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Middle-aged adults (45–64 years) had the highest population-specific mortality and experienced at least a 20% relative increase across all 4 regions from 2000–2009 to 2010–2017. Although men and women also experienced increases in mortality, these death rates remained more than twofold higher in men in each region. Based on race/ethnicity, non-Hispanic Whites experienced the largest relative change in mortality in all four regions from 2000–2009 to 2010–2017 and surpassed mortality in non-Hispanic Blacks in the Northeast, Midwest, and South from 2000–2009 to 2010–2017. Non-Hispanic Blacks were the only sociodemographic subgroup that experienced a decline in mortality. Although mortality among Hispanics remained relatively unchanged, mortality among Hispanics in the West surpassed that of all other race/ethnicities in any region.

State-specific mortality from alcohol-induced causes in 2000–2009 and 2010–2017 is depicted in Fig. 1. All states except Alaska and Maryland experienced an increase in mortality. From 2000 to 2009, only two states, Alaska (19.7) and New Mexico (18.6), had a mortality surpassing 15 deaths per 100,000 persons. However, from 2010 to 2017, this number increased to seven states, all from the Southwest and Northwest sections of the West region including New Mexico (25.2), Alaska (18.7), Wyoming (18.3), Arizona (16.0), Oregon (16.0), South Dakota (15.9), and Montana (15.5). Moreover, 32% (16) of US states had mortality surpassing 10 deaths per 100,000 persons from 2010 to 2017.

Figure 1
figure 1

Comparison of state-specific mortality rates from alcohol-induced causes in the United States from 2000 through 2009 and 2010 through 2017. a Age-adjusted mortality rate from alcohol-induced causes in the United States by state from 2000 through 2009. b Age-adjusted mortality rate from alcohol-induced causes in the United States by state from 2010 through 2017.

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DISCUSSION

Mortality from alcohol-induced causes increased in all four regions of the US with highest rates in the West—largely attributed to states in the Southwest (Arizona and New Mexico) and Northwest (Wyoming, Oregon, and Montana). More importantly, while these data highlight the ongoing regional increase in mortality in nearly all sociodemographic groups; middle-aged adults, men, and non-Hispanic Whites in all regions as well as Hispanics in the West were seemingly at highest risk. These ominous trends warrant a comprehensive plan by the policy makers in the federal government in conjunction with a targeted approach by stake holders at the state level. These data may help health care providers on a regional/state level to focus on preemptive screening, counselling, and intervention in the primary care setting among at-risk subpopulations.