The leading causes of death in 2000 (the latest figures
available) show alcohol consumption the third highest cause of death in
the country.
The Journal
of the American Medical Association, Jan. 19, 2005, Vol. 293, No. 3, p.
298, reported on the leading causes of death in the United States:
- Tobacco (435,000 deaths; 18.1% of total US deaths)
- Poor diet and physical inactivity (400,000 deaths; 16.6%)
- Alcohol consumption (85,000 deaths; 3.5%)
(Note: 16,653 deaths from alcohol-related vehicle crashes are
included in both Alcohol consumption above and Motor vehicle crashes
below.)
- Microbial agents (75,000)
- Toxic agents (55,000)
- Motor vehicle crashes (43,000)(see Note above)
- Incidents involving firearms (29,000)
- Sexual behaviors (STDs, hepatitis B and C, and cervical cancer)
(20,000)
- Illicit use of drugs (17,000)
The Alcohol Related Death Study Methodology
We used 2 large nationally representative surveys to determine US
alcohol consumption. The National Health Interview Survey, a household
survey that measured alcohol intake in 1999 and 2000, and the BRFSS, a
telephone survey that measured alcohol intake in 1999.
We used RRs from the Australian National Drug and Safety Report that
were based on mortality rates derived from pooled data of several
studies. The RR values were 1.33 for hazardous drinking (4.01-6.00
drinks/d for males and 2.01-4.00 for females) and 1.47 for harmful
drinking (6.01 drinks/d for males and 4.01 for females) in contrast to
low levels of drinking (0.26- 4.00 drinks/d for males and 0.26-2.00 for
females) and abstinence (0-0.25 drinks/d for both males and females).
We used BRFSS data to compute the number of alcohol-attributable
deaths for the US population aged 18 years or older. The BRFSS also
asked questions about binge drinking (i.e., 5 drinks per occasion). To
account for the effect that respondents appeared not to include binge
drinking in their reported regular drinking, we reran our analyses,
adding 5 drinks per binge occasion to average drinks per day. The total
number of deaths attributable to alcohol was 103,350.
We also used 3 other recent studies to estimate alcohol-attributable
mortality. Two studies were based on the National Health Interview
Survey29,30 and the National Alcohol Survey. Using all-cause mortality
and RRs from these studies, we estimated approximately 60,000 deaths per
year. This difference in number of deaths is mainly due to the fact that
BRFSS respondents report a higher percentage of heavy drinking than do
respondents in a household survey such as the National Health Interview
Survey.
In another approach, we aggregated alcohol-related deaths from
specified ICD codes that were summed to provide an overall estimate of
deaths. In 2000, 18,539 deaths were reported as alcohol- induced (ICD-10
codes F10, G31.2, G62.1, I42.6, K29.2, K70, R78.0, X45, X65). In
addition, 16,653 persons were killed in alcohol-related crashes.
We estimate another 34,797 deaths in 2000 using BRFSS alcohol
consumption data and disease-specific RRs from the Australian study for
oropharyngeal, esophageal, liver, laryngeal, and female breast cancers;
stroke; hypertensive heart disease; and other chronic liver disease and
cirrhosis (ICD-10 code K73-74). This totals to 69,989 deaths in 2000
from these factors alone. In the Australian study, all-cause mortality
was also higher than the summation of cause-specific mortality.
Total alcohol-attributable deaths would reach about 140,000 if
mortality among previous alcohol drinkers were included. It is unclear
whether excess mortality among former alcohol drinkers is due to damage
or illness from past alcohol consumption.
Taking these various numbers into account, our best estimate for
total alcohol-attributable deaths in 2000 is approximately 85,000, based
on the conservative estimate from cause-specific deaths and the high
estimate using all-cause mortality. This is a reduction of 15,000 deaths
from the 1990 estimates.
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