Alcohol-induced mortality trends in the US
To examine the mortality impacts of alcohol on the US population, RGA studied the alcohol-induced mortality trends through an analysis of the mortality data from the National Vital Statistics System.18,19 Findings revealed that alcohol-induced mortality rates have been increasing over time, with sharper increases occurring in the first few years of the COVID-19 pandemic.
When analyzing trends within the US, increases in alcohol-induced mortality began to slow in 2017-2019, with a significant uptick in 2020, coinciding with the COVID-19 pandemic. Interestingly, alcohol-induced mortality rates appear to have decreased in 2022. Such trends were noticed across all education levels, but the trends specific to university-educated individuals can be especially telling for a potentially insured population, as shown in Figure 1.
Figure 1. Alcohol-induced mortality rates for university-educated individuals age 25+ in the US, 2007-2022
Source: RGA analysis of of National Center for Health Statistics, National Vital Statistics System, mortality data files
As shown in Figure 2, later-middle-aged individuals experience the highest alcohol-induced mortality. These age trends are possibly attributable to the long-term nature of alcohol-related conditions. For example, it may take many years of harmful alcohol consumption to develop alcohol-associated hepatic steatosis and even more years to progress to alcohol liver cirrhosis.20 This also does not mean immediate death, as the life expectancy of people with cirrhosis is two to 14 years.
Figure 2. Alcohol-induced mortality rates by age and marital status in the US in 2022
Source: RGA analysis of National Center for Health Statistics, National Vital Statistics System, mortality data files
Note: Due to data limitations, the comparison for age and marital status was not limited to university-educated individuals, as shown in Figure 1.
Marital status is also an indicator of alcohol-induced mortality risk. Never-married individuals exhibit elevated alcohol-induced mortality rates as high as nearly four times the alcohol-induced mortality rates of their once-married counterparts for certain ages. This difference generally decreases with age.
Alcohol consumption and mortality trends are rapidly evolving. Assessing the provisional mortality data for the general US population reveals a decreasing trend in alcohol-induced mortality rates for adults ages 25+ beginning in 2022 and extending into 2023. Will these decreasing trends continue? Will mortality return to pre-pandemic levels? Only time will tell, but the provisional US trends provide some hope, as shown in Figure 3.
Figure 3. Provisional alcohol-induced mortality rates for age 25+ in the US, 2018-2023
Source: RGA analysis of of National Center for Health Statistics, National Vital Statistics System, provisional mortality data files on CDC WONDER Online Database
Note: Due to data limitations, this analysis is not limited to the university-educated population as shown in Figure 1. Deaths through Nov. 2, 2024, as of Nov. 10, 2024. Data for 2024 was excluded due to being a partial year at the time of analysis. As noted within CDC WONDER: “The July 1, 2022, population estimates are used as denominators for calculating provisional death rates in year 2022 and later years.”
Comparison to experience in England and Wales
The concerning alcohol-induced mortality trends are not exclusive to the US. A University of Sheffield report based on data from England documented the changes in the prevalence of risky drinking behavior from the pandemic. It showed that adults in England had greatly increased risky drinking during the pandemic relative to prior years. More specifically, individuals who were considered high-risk drinkers showed increases in risky drinking behavior, while low-risk drinkers actually showed decreases in risky drinking behavior. Among risky drinkers, males and the 25–34 age group saw the largest increases.21
Similar to the US, England and Wales experienced higher alcohol-specific mortality among later-middle-aged groups. England and Wales also saw an increasing mortality trend with a spike that coincided with the COVID-19 pandemic. However, in England and Wales, this trend continued through 2022, unlike in the United States, where alcohol-specific mortality experience has improved.22
Figure 4. Alcohol-specific deaths in England and Wales, 2001-2022
Source: Mortality data from ONS, population data from mortality.org | Plot by @VictimOfMaths | Provided by Colin Angus with permission
The University of Sheffield report also projected alcohol-specific excess deaths in England based on a variety of alcohol consumption scenarios, as shown in Figure 5.23 Unsurprisingly, the worst-case scenario—alcohol consumption increases further24—showed the highest projected excess deaths, which continue for many years. Notably, when comparing these projections to the first few years of actual excess deaths (indicated as orange data points), the actual excess deaths from alcohol were even higher than this scenario.25
Figure 5. Modeled vs actual deaths in England
Source: Alcohol-specific deaths data from ONS | Modelled scenarios from Angus et al. 2023 | Plot by @VictimOfMaths | Provided by Colin Angus with permission
The experience noted in England presents some alarming findings, such as higher-than-projected alcohol-specific excess deaths, as well as an increasing trend through 2022. Could this indicate that further increases may continue? Or will England perhaps experience a decrease similar to the US? It is difficult to predict, but the findings emphasize the need for further analysis and ongoing monitoring.
Conclusion
Excessive alcohol consumption increases the risk of liver disease and early death. Alcohol is a cause or factor in up to 80% of liver-related deaths and the leading cause of death and disability in those 15–49 years old. Rates of liver cancer have been rising steadily over the past two decades, while rates of liver transplants for alcohol-related liver disease also increased during the same period. As diseases and deaths from ALD are predicted to continue to increase, there are rising concerns as to how life insurance claims related to excess alcohol use will be affected.
RGA analyzed general US population data and found that alcohol-induced mortality has generally increased over the past 15+ years, with a spike occurring during the early phases of the COVID-19 pandemic. More recent data in 2022 and provisional 2023 data provide hope that reductions in alcohol-induced mortality may be on the horizon for the US.
England and Wales experienced similar increases, especially for certain demographic groups during the acute phase of the COVID-19 pandemic. However, rather than slowing down in 2022 as in the US, those increases continued in England and Wales. This difference between the two regions highlights the need to monitor and analyze alcohol-induced mortality trends across different geographies to understand the broader story around alcohol consumption and mortality.
Appendix
CDC Multiple Cause of Death Analysis – Data Notes and Cause of Death Definition
RGA analyzed data from the CDC Multiple Cause of Death mortality files. The analysis depicted in Figures 1 and 2 was derived from the final mortality data files, while Figure 3 was derived from the provisional data files. These mortality files contained demographic variables such as age, marital status, and education, along with underlying and multiple causes of deaths indicating up to 20 contributing conditions to the death record. Population data was obtained from the U.S. Census Bureau26 in order to calculate mortality rates for the final mortality data by specific demographic variable. Provisional data had population numbers included by the CDC. Thus, there are slight differences in population counts used to calculate mortality rates, but these were determined to be immaterial for the purpose of this research.
In defining an alcohol-induced death, records with the following ICD-10 codes marked in the underlying cause of death were included:
- E24.4 Alcohol-induced pseudo-Cushing’s syndrome
- F10 Mental and behavioral disorders due to use of alcohol
- G31.2 Degeneration of nervous system due to alcohol
- G62.1 Alcoholic polyneuropathy
- G72.1 Alcohol myopathy
- I42.6 Alcoholic cardiomyopathy
- K29.2 Alcoholic gastritis
- K70 Alcoholic liver disease
- K85.2 Alcohol-induced acute pancreatitis
- K86.0 Alcohol-induced chronic pancreatitis
- R78.0 Excess alcohol blood levels
- X45 Accidental poisoning by and exposure to alcohol
- X65 Intentional self-poisoning by and exposure to alcohol
- Y15 Poisoning by and exposure to alcohol, undetermined intent
Note: Other studies may define “alcohol-specific,” “alcohol-induced,” “alcohol-attributable,” or “alcohol-related” deaths differently.