Alcohol-Linked Deaths Rise Sharply in Rural America
In rural America, drinking has become particularly deadly for many, a new government report shows.
Deaths related to alcohol use in those regions rose 43% between 2006 and 2018, health officials reported.
Over that time, the rate of deaths went from 11 per 100,000 people to 15 per 100,000. Also, the rate of deaths among women more than doubled, according to researchers from the U.S. Centers for Disease Control and Prevention.
"I really want to highlight this health disparity, the fact that there is an increase in rural areas in recent years," said lead researcher Merianne Spencer, from the division of analysis and epidemiology at the CDC's National Center for Health Statistics (NCHS).
"Hopefully, we can take it to the next step, and other researchers can delve into this question, because we are seeing this at the national level," Spencer added.
For the report, the researchers included deaths from alcohol-related medical conditions, such as cirrhosis of the liver, but not causes indirectly related to alcohol use, such as motor vehicle crashes or suicides, Spencer explained.
"These increases in alcohol-related deaths may well be connected to the fairly recently described phenomenon of lowered life expectancy in the United States over the past few years, primarily in white individuals with lower educational achievement," said Dr. J.C. Garbutt, an adjunct professor of psychiatry at the University of North Carolina School of Medicine in Chapel Hill.
"I do think that 'deaths of despair' is a contributing factor. The meaning of this is complex, but has been thought to connect to a variety of social and employment disruptions," he added.
Overall, the data indicate a need to educate people about the health consequences of alcohol, especially heavy drinking, said Garbutt, who was not connected to the study.
Using data from the National Vital Statistics System, Mortality, Spencer's team found:
- Deaths from alcohol among people 25 and older increased more for rural men and women, compared with those in urban areas.
- In 2000, deaths from alcohol among men were highest among those living in cities at 21 per 100,000. By 2018, most alcohol-related deaths were in small towns at 27 per 100,000, and rural areas at 25 per 100,000.
- Among women, the rate of alcohol-induced deaths in rural areas in 2000 was among the lowest at 4 per 100,000. By 2018, these rates had more than doubled to nearly 10 per 100,000.
The findings were published Oct. 1 in the NCHS report Rates of Alcohol-Induced Deaths Among Adults Aged 25 Years and Over in Urban and Rural Areas: United States, 2000-2018.
Robyn Oster, a research associate in health law and policy at the Partnership to End Addiction, said several factors may contribute to alcohol-related deaths in rural areas.
"Rural areas lack sufficient treatment capacity, with few treatment providers and facilities, particularly for addiction treatment, to help those with alcohol use disorder," she said.
Stigma may also be a problem in rural areas, where relationships are close-knit and there may be less privacy. "This can prevent people from seeking needed treatment and support. High unemployment or other poor economic conditions could also play a role," said Oster, who was not part of the study.
Alcohol-related deaths go along with the increases in deaths from drug overdoses and suicides. "Many people have comorbid mental health and substance use disorders, and alcohol use can contribute to drug overdoses and suicides," she said.
Some of the deaths may be related to economic decline, Oster said. "Some studies have linked economic conditions, such as job loss or unemployment, to alcohol deaths," she noted.
To curb these deaths, there needs to be increased access to quality affordable treatment, including medications such as naltrexone, as well as behavioral therapy. Mutual support groups can also provide valuable support, Oster said.
Also, laws that reduce the concentration of alcohol retailers, increase taxes on alcohol, reduce alcohol marketing and enhance enforcement of laws prohibiting sales to minors can also help reduce alcohol misuse, she pointed out.
"Addressing underlying social determinants, treatment access, stigma and other barriers can help curb deaths related not just to alcohol but to other mental health and substance use disorders as well," Oster said.
For more on alcohol abuse, head to the U.S. National Institute on Alcohol Abuse and Alcoholism.
SOURCES: Merianne Spencer, M.P.H., division of analysis and epidemiology, National Center for Health Statistics, U.S. Centers for Disease Control and Prevention; Robyn Oster, B.A., research associate, health law and policy, Partnership to End Addiction; J.C. Garbutt, M.D., adjunct professor, psychiatry, University of North Carolina School of Medicine, Chapel Hill; Rates of Alcohol-Induced Deaths Among Adults Aged 25 Years and Over in Urban and Rural Areas: United States, 2000-2018, Oct. 1, 2020