Using mortality data from the Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research and other sources, the study’s authors identified approximately 605,000 alcohol-related deaths in the U.S. between 1999 and 2020. The overall age-adjusted mortality rate (AAMR) for the period was 8.3 per 100,000 persons, but was significantly higher for men (12.7 per 100,000) than women (4.3 per 100,000.)

Both the overall rate and the gender-based differences stayed relatively stable from 1999 to 2005. Starting in 2005, however, the death rates increased and the gap between men and women got smaller. From 2005 to 2011 the overall rate grew by 1.7%, but for men the annual percentage change was 3% and for women 4%.

The difference narrowed further between 2011 and 2019. The overall rate accelerated to 3.8% per year, but for women the annual change was 14.7% versus 12.5% for men.

The most frequent cause of alcohol-related deaths during the period was alcoholic liver disease, for which the AAMR was 5.1 per 100,000. That was followed by “mental and behavioral disorders due to use of alcohol, acute intoxication” (2.4 per 100,000) and alcohol poisoning (.05 per 100,000). Rates were higher among men for all causes.

Women’s growing use of alcohol raise several public health concerns due to metabolic and physiological gender-based differences, the authors say. For example, women tend to have a higher percentage of body fat and a lower percentage of body water than men, leading to higher alcohol blood concentrations and a greater vulnerability to complications.

In addition, women have lower levels of alcohol-metabolizing enzymes, with the result that they face a higher risk of developing liver diseases, circulatory disorders and breast cancer, among other health problems.

The authors say that changing patterns of alcohol consumption among women lies behind the trends revealed in the study. “Women are now drinking alcohol at higher amounts and frequency than in the past, likely due to the normalization of alcohol use for female individuals,” they write.

They note that coping with stress is one of the main reasons for initiating alcohol misuse for both men and women, and thus “the narrowing gap in sex differences for alcohol mortality rates…may reflect an increase in stress levels and stress-related disorders among women” in recent years.

They recommend further research to identify the psychosocial and environmental factors associated with the faster growth of alcohol-related deaths, with a special focus on treatments to address alcohol use among women.

The study, “Trends in Alcohol-Related Deaths by Sex in the US, 1999-2020” was published July 28, 2023 in JAMA Network Open.