U.S. deaths related to alcohol use disorder (AUD) exceeded expectations for the second year in a row, with the most dramatic increase among young adults, according to a study published Wednesday in JAMA Network Open.

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Study details and key findings

For the study, researchers analyzed 343,384 AUD-related deaths that occurred between 2012 and 2021 using data from CDC's National Vital Statistics System and the Wide-Ranging Online Data for Epidemiologic Research (WONDER) database.

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From 2012 to 2019, there was a steady increase in AUD-related deaths, both when AUD was listed among multiple causes (from 10.6 to 15.1 per 100,000, respectively) and when AUD was listed as the primary cause (from 3.1 to 4.6 per 100,000, respectively).

In 2021, deaths where AUD was listed among multiple causes were 22% higher than expected (20.0 vs 16.4 per 100,000) and 28.8% higher in cases where AUD was listed as the primary underlying cause (6.4 vs 5.0 per 100,000).

Of these deaths, 56% occurred in adults ages 45 to 64 years, 27.4% occurred in people 65 and older, and 16.6% occurred in adults ages 25 to 44. While all subgroups experienced significant increases in AUD-related deaths during the pandemic, adults ages 25 to 44 saw the largest increases (40.47% in 2020 and 33.95% in 2021).

During the study period, 77.7% of the deaths involved men, with similar increases in AUD-related deaths for both men and women.

According to the study authors, just 10% of the deaths included in the study were Covid-related, which suggests "that excess deaths were more likely attributable to indirect effects of the pandemic such as stay-at-home policies and reduced medical and social resources for patients with AUD."

The study reinforces the continuation of AUD-related trends seen during the pandemic.

Commentary

Notably, researchers reported a similar pattern in 2020, with AUD-related deaths 24.8% higher than expected based on trends from the previous eight years and 30.7% higher in cases where AUD was listed as the underlying cause.

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"Physicians and frontline providers should recognize the uprising trend of alcohol use, withdrawal, and mortality," said lead author Yee Hui Yeo of Cedars-Sinai Medical Center. "During the pandemic, healthcare delivery for individuals with AUD was substantially shattered."

According to Yeo, physicians in both inpatient and outpatient settings should focus on reversing the growing gaps in care for those with AUD.

"A big wave of AUD-related complications (liver diseases, mental health issues, etc.) are surging now due to the loss to follow-up, progressive disease, or misdiagnosis during the pandemic, and we are not well prepared," he said.

While the pandemic triggered a surge in telemedicine, Yeo noted that its effective use among patients with AUD and the "compliance and attrition using telemedicine remain unknown."

In addition, Yeo highlighted that lower socioeconomic status, reduced access to health care, and medical noncompliance are relatively common among individuals with AUD, and these challenges should be considered in treatment plans to provide the best possible care. (Ingram, MedPage Today, 5/4; Yeo et al., JAMA Network Open, 5/4)