New cross-sectional data show the sex gap in alcohol-related mortality has been narrowing since 1999, as women have become more susceptible to alcohol use and related diseases.
Though alcohol-related deaths continue to predominately impact men, the age-adjusted mortality rate among women has increased at a greater rate in the last 20 years, according to new data.1
In research from a team of US-based investigators, the rate of alcohol-related mortality was nearly three-fold greater among men versus women as of 2020. However, in the same dataset, the investigators observed that women reported a more significant percent-change increase in annual alcohol-related deaths than men from 1999 – 2020.
The findings, which come at a time when alcohol consumption has comprised the fourth leading cause of preventable death in the US, elucidate a narrowing gap of gender disparity in alcohol-related deaths—and highlight the need for gender-specific methods of care for alcohol use disorder (AUD).
A team of investigators led by Ibraheem M. Karaye, MD, DrPH, of the department of population health at Hofstra University, conducted a cross-sectional analysis of Centers for Disease Control and Prevention (CDC) data to interpret sex differences in the burden and trends of alcohol-related deaths in the US from 1999 – 2020. With alcohol resulting in approximately 140,000 American deaths annually and being implicated in up to 1 in every 5 emergency department visits, the investigators sought to update understanding of sex-based differences in alcohol-related outcomes.
Due to biological differences to men, women with AUD are generally at greater risk of liver diseases, circulatory disorders, breast cancer, fertility issues and early-onset menopause.
“Although recent studies note a narrowing sex gap in alcohol-related harm, it remains unclear whether this convergence extends to alcohol-related death rates,” investigators wrote. “Given the public health significance of alcohol and the reported changes in female alcohol consumption, there is a need to conduct a comprehensive assessment of sex differences in alcohol-associated deaths using contemporary data.”
Karaye and colleagues identified alcohol-related deaths derived from the CDC epidemiological data using ICD-10 coding for alcohol-related poisoning; liver disease; gastritis; cardiomyopathy; myopathy; polyneuropathy; and pseudo-Cushing syndrome, among other relevant conditions. They analyzed age-adjusted mortality rates (AAMRs) by sex, with sub-stratifications for patient race, ethnicity, age and census region.
Their final analysis included 605,948 deaths attributed to alcohol in the US from 1999 – 2020—indicating an AAMR of 8.3 per 100,000 persons (95% CI, 8.3 – 8.3). Patients to die from alcohol-related conditions were primarily American Indian or Alaska Native (AAMR, 38.7 per 100,000; 95% CI, 38.1 – 39.2), Hispanic (AAMR, 9.7; 95% CI, 9.6 – 9.8), or White (AAMR, 8.4; 95% CI, 8.4 – 8.4). Patients were primarily 45 – 64 years old (AAMR, 21.5; 95% CI, 21.5 – 21.6) and from the West region (AAMR, 12.4; 95% CI, 12.3 – 12.4).
The leading cause of alcohol-related deaths were liver disease (AAMR, 5.1) and mental and/or behavioral disorders (AAMR, 2.4).
Men reported a 2.88 mortality rate ratio over women in the observed time period, with 12.7 AAMR per 100,000 versus 4.3 per 100,000, respectively. However, the AAMR increased by just 12.5% (95% CI, 6.4 – 19.1) per year among men from 2018 – 2020; among women in the same time period, it increased 14.7 (95% CI, 9.1 – 20.5).
The team noted their findings correlate with data showing women are consuming greater rates of alcohol at higher frequencies now, “likely due to the normalization of alcohol use for female individuals in society.”
“The change in the mortality rate trends perhaps parallels the changing patterns in general alcohol consumption as well as in disordered or harmful patterns of consumption (such as binge drinking) where the sex gap has also been closing globally,” they wrote. “It is likely that the narrowing gap in sex differences for alcohol mortality rates, which also parallels the narrowing gap in the patterns of alcohol use and misuse, may be reflective of an increase in stress levels and stress-related disorders among women in recent decades and, particularly, in recent years.”
The data also align with recent findings showing alcohol-associated hepatitis has increased 7-fold among women from 2000 – 2018, from a team of Mayo Clinic investigators.2
Karaye and colleagues concluded their findings suggest a number of sociocultural, economic, biological and behavioral factors impacting the narrowing sex gap of alcohol-related mortality among men and women in the US.
“Further research is necessary to identify the psychosocial and environmental factors associated with these trends and guide evidence-based interventions aimed at reducing alcohol-related mortality risks for all individuals, with a particular focus on developing targeted treatments to address alcohol use among female individuals,” they wrote.