Deaths from alcohol use disorder surged during pandemic

Deaths involving alcohol use disorder increased dramatically during the pandemic, according to a new study by Cedars-Sinai investigators. The study also found that young adults 25 to 44 years old experienced the steepest upward trend in alcohol use disorder mortality.

In the study, published this month in JAMA Network Open, investigators used predictive modeling to compare expected—also called projected—alcohol use disorder mortality rates to actual rates. They found that alcohol use disorder-related mortality rates increased among all ages and sexes during the pandemic.

"During the first few months of the pandemic, my colleagues and I saw increased numbers of patients being treated for acute alcohol use-related conditions in the intensive care unit and through out the medical center," said Yee Hui Yeo, MD, MSc, lead author of the study. "We also became aware of reports from single centers of elevated alcohol use-related complications. That prompted us to think, maybe this is a significant public health crisis."

Investigators obtained de-identified mortality data for seven years—2012-2019—from a Centers for Disease Control and Prevention database that registers more than 99% of all deaths in the U.S. They then used predictive modeling to determine 2020 and 2021 projected mortality rates based on previous years' trends, and compared those with the rates that were actually observed.

"What we found in our analysis reflects what we had been seeing anecdotally in our patients and in academic papers tracking complications like alcohol-related liver disease," Yeo said.

Results include:

• In 2020, the observed alcohol use disorder-related deaths were about 25% higher than the projected rates.
• In 2021, the observed rates were about 22% higher than projected.
• The increase in predicted versus observed mortality was similar for both sexes—approximately 25% for women and men in 2020 versus 20% for women and 22% for men in 2021.
• Although the older adult group had the highest mortality rate throughout the study period, it was the younger group (ages 25-44 years) who suffered the greatest surge during the pandemic, which warrants public attention.

"We also know that alcohol use disorder is often under-reported, so actual mortality rates related to alcohol use may be even higher than reported," Yeo said.

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, the reference that mental health professionals use to categorize mental health disorders, defines alcohol use disorder as "a problematic pattern of alcohol use leading to clinically significant impairment or distress, as manifested by at least two of the following, occurring within a 12-month period."

The manual then lists 11 criteria, such as a craving or strong urge to use alcohol; recurring use of alcohol that results in a failure to fulfill obligations at school, work or home; and continued alcohol use despite having persistent social or interpersonal problems that are created or exacerbated by alcohol use.

"In publishing this article, we want everyone, especially policymakers and physicians on the front lines, to know that during the pandemic, there is really a significant surge in alcohol use disorder-related deaths," Yeo said. "We also want to recognize that patients who die from alcohol use disorder-related causes tend to have social determinants of health, like lower socioeconomic status, that can make it harder for them to access healthcare and help. Finally, we want to make sure that patients who do seek treatment for alcohol or substance use have access to follow-up care to prevent secondary complications."