The US Centers for Disease Control and Prevention (CDC) convened a scientific workgroup comprised of experts on alcohol and health to guide the development of the ARDI application. One of the group’s tasks was to select alcohol-related causes of death based on ones that were previously examined in meta-analyses. Some causes (e.g., tuberculosis, pneumonia, and hepatitis C) were not included in this version of ARDI because suitable pooled relative risk estimates or alcohol-attributable fractions (AAF) were not available for them at the time the work group convened.
Excessive alcohol consumption, the fourth leading preventable cause of death in the United States, resulted in approximately 88,000 deaths and 2.5 million years of potential life lost (YPLL) annually during 2006–2010 and cost an estimated $223.5 billion in 2006. To estimate state-specific average annual rates of alcohol attributable deaths (AAD) and YPLL caused by excessive alcohol use, different states analyzed 2006–2010 data (the most recent data available) using the CDC Alcohol Related Disease Impact (ARDI) application.
Certain causes of death are, by definition due to alcohol consumption. These deaths are classified as being 100% alcohol attributable and are reported in ARDI as having an AAF of 1.00. The following chronic causes of death are listed as 100% alcohol attributable in ARDI: alcoholic psychosis, alcohol abuse, alcohol dependence syndrome, alcohol polyneuropathy, degeneration of the nervous system due to alcohol use, alcoholic myopathy, alcohol cardiomyopathy, alcoholic gastritis, alcoholic liver disease, fetal alcohol syndrome, fetus and newborn affected by maternal use of alcohol, alcohol-induced chronic pancreatitis. Three acute causes of death are 100% alcohol attributable: alcohol poisoning, excessive blood alcohol level, and suicide by and exposure to alcohol.
The findings for this dataset are subject to the following seven limitations:
– ARDI exclusively uses the underlying cause of death and does not consider contributing causes that might be alcohol-related.
– ARDI does not include AAD estimates for several causes (e.g., tuberculosis) for which excessive alcohol use is believed to be an important risk factor.
– The alcohol data used to calculate AAF estimates were based on self-reports and might underestimate the actual prevalence of excessive alcohol use.
– State estimates calculated in this study might be different than those available in the ARDI application.
– National AAF data were used, even though studies suggest that there are important state differences in AAF for some causes of alcohol attributable deaths.
– AAD and YPLL rates could not be calculated for some age and race/ethnicity categories because of the small number of AAD in some of these groups.
The Community Preventive Services Task Force has recommended several population-level, evidence-based strategies to reduce excessive drinking and related harms, including:
– Increasing the price of alcohol
– Limiting alcohol outlet density
– Holding alcohol retailers liable for harms related to the sale of alcoholic beverages to minors and intoxicated patrons.
Routine monitoring of alcohol attributable health outcomes, including deaths and YPLL, in states could support the planning and implementation of evidence-based prevention strategies to reduce excessive drinking and related harms.