Alcohol-related deaths, which increased during the first year of the COVID-19 pandemic, continued to rise in 2021
Alcohol-related deaths among individuals ages 16 and older, which increased during the first year of the pandemic, continued to increase during the second year of the pandemic, according to new analyses of 2021 mortality data by National Institute on Alcohol Abuse and Alcoholism (NIAAA) researchers.1 In a previous study, they reported that alcohol-related death numbers soared 25.5% between 2019 to 2020, the first year of the pandemic.2 During the two decades prior to the pandemic, age-adjusted alcohol-related death rates increased around 2.2% per year.3
The figure above shows the number of alcohol-related deaths each month in 2019, 2020, and 2021. The annual total number of deaths increased 25% between 2019 and 2020 (from 78,927 to 99,017). The annual total number increased another 10% between 2020 and 2021 (from 99,017 to 108,791). A death was considered alcohol-related if alcohol was listed in a death certificate as the primary cause (e.g., alcohol-associated liver disease) or a contributing factor (e.g., death from a fall while intoxicated).
In the new analyses, a total of 108,791 death certificates of individuals ages 16 and older listed alcohol as either the primary cause or a contributing factor in 2021, an increase of 9.9% over the previous year. Increases were similar for males (9.8%) and females (10.1%), and occurred for nearly all age groups. Deaths involving alcohol-associated liver disease increased from 29,504 in 2020 to 33,097 in 2021 (12.2% increase), while deaths due to drug overdoses with alcohol increased from 15,201 in 2020 to 17,148 in 2021 (12.8% increase). Overall, alcohol played a role in 3 out of 100 (3.2%) deaths at age of 16 years or older in the United States in 2021.
Scientists continue to explore possible reasons for the increase in alcohol-related deaths during the pandemic. In 2020, sales of alcohol increased by 2.9%, the largest annual increase in over 50 years, but it is not yet known whether sales grew in 2021.4 Research suggests that some people increased their alcohol consumption in an effort to cope with pandemic-related stress and anxiety. This was particularly common for people with pre-existing struggles with anxiety, depression, and alcohol misuse.5,6,7
The increase in alcohol-related deaths appears to reflect a widespread increase in alcohol-related harms during the pandemic. For example, there were increases in both the numbers of transplants for alcohol-associated liver disease and emergency department visits for alcohol withdrawal, as well as the percentage of emergency department visits that involved acute alcohol consumption. 8,9,10 Additionally, after decades of a general decline, the National Highway Traffic Safety Administration reported a 14% increase in alcohol-related traffic fatalities in 2020.11
1 U.S. Department of Health and Human Services, Centers for Disease Control and Prevention (CDC) [Internet]. National Center for Health Statistics Mortality Data on CDC WONDER. Multiple cause of death, 2018–2021. 2023. [cited 2023 Feb 9]. Available from: https://wonder.cdc.gov/controller/saved/D157/D324F825
2 White AM, Castle IP, Powell PA, Hingson RW, Koob GF. Alcohol-related deaths during the COVID-19 pandemic. JAMA. 2022 May 3;327(17):1704–1706. PubMed PMID: 35302593
3 White AM, Castle IP, Hingson RW, Powell PA. Using Death Certificates to Explore Changes in Alcohol-Related Mortality in the United States, 1999 to 2017. Alcohol Clin Exp Res. 2020 Jan;44(1):178-187. Epub 2020 Jan 7. PMID: 31912524.
4 Slater ME, Alpert HF, Surveillance Report #119: Apparent Per Capita Alcohol Consumption: National, State, and Regional Trends, 1977-2020. Sterling (VA): NIAAA, Division of Epidemiology and Prevention Research; 2022 Apr. 66 p. Contract No.: HHSN275201800004C. https://pubs.niaaa.nih.gov/publications/surveillance119/CONS20.htm
5 Acuff SF, Strickland JC, Tucker JA, Murphy JG. Changes in alcohol use during COVID-19 and associations with contextual and individual difference variables: a systematic review and meta-analysis. Psychol Addict Behav. 2022 Feb;36(1):1–19. PubMed PMID: 34807630
6 Capasso A, Jones AM, Ali SH, Foreman J, Tozan Y, DiClemente RJ. Increased alcohol use during the COVID-19 pandemic: the effect of mental health and age in a cross-sectional sample of social media users in the U.S. Prev Med. 2021 Apr;145:106422. PubMed PMID: 33422577
7 Grossman ER, Benjamin-Neelon SE, Sonnenschein S. Alcohol consumption during the COVID-19 pandemic: a cross-sectional survey of US adults. Int J of Environ Res Public Health. 202 Dec 9;17(24):9189. PubMed PMID: 33316978
8 Cholankeril G, Goli K, Rana A, Hernaez R, Podboy A, Jalal P, Da BL, Satapathy SK, Kim D, Ahmed A, Goss J, Kanwal F. Impact of COVID-19 pandemic on liver transplantation and alcohol-associated liver disease in the USA. Hepatology. 2021 Dec;74(6):3316–3329. PubMed PMID: 34310738
9 Sharma RA, Subedi K, Gbadebo BM, Wilson B, Jurkovitz C, Horton T. Alcohol withdrawal rates in hospitalized patients during the COVID-19 pandemic. JAMA Network Open. 2021 March 1;4(3):e210422. PubMed PMID: 33656526
10 Esser MB, Idaikkadar N, Kite-Powell A, Thomas C, Greenlund KJ. Trends in emergency department visits related to acute alcohol consumption before and during the COVID-19 pandemic in the United States, 2018-2020. Drug Alcohol Depend Rep. 2022 Jun;3:100049. PubMed PMID: 35368619
11 National Center for Statistics and Analysis, National Highway Traffic Safety Administration. Overview of Motor Vehicle Crashes in 2020 [Internet]. Washington: U.S. Department of Transportation; 2020 Mar [cited 2022 June 20]. 43 pp. Available from: https://crashstats.nhtsa.dot.gov/Api/Public/ViewPublication/813266