Deaths attributed to alcohol use in the United States have dramatically increased over the past two decades, with rates for both alcohol-related liver disease and alcohol-associated cancers showing alarming surges. This rise accelerated during and persisted beyond the COVID-19 pandemic, highlighting a growing public health crisis.
Between 1999 and 2020, the overall number of alcohol-related deaths in the U.S. more than doubled, climbing from just over 19,300 to nearly 49,000 annually. The mortality rate per 100,000 people also doubled during this period, jumping from 10.7 to 21.6. Experts link high levels of alcohol consumption globally and within the U.S. directly to premature deaths and disability.
Liver Disease Deaths Skyrocket
Specifically focusing on alcohol-related liver disease, a study published in JAMA Network Open analyzed over 436,000 deaths between 1999 and 2022. It found that the U.S. death rate from this condition roughly doubled over the study period. This increase saw a particularly sharp annual surge of 9% between 2018 and 2022. Researchers suggest this acceleration was exacerbated by pandemic-related stressors like financial insecurity and social isolation, which led to increased drinking patterns that appear to have lasting effects.
The Growing Toll of Alcohol-Related Cancers
Beyond liver disease, alcohol is a known carcinogen linked to at least six types of cancer, including liver, breast, colorectal, esophageal, and certain head and neck cancers. A separate analysis, presented at the American Society of Clinical Oncology 2025 conference, revealed that deaths from alcohol-associated cancers also more than doubled between 1990 and 2021, rising from nearly 11,900 to over 23,200 deaths annually. Public health officials note that despite increasing awareness, alcohol remains a significant contributor to cancer mortality.
Who is Most Affected?
While the increase spans most demographics, certain groups are experiencing disproportionately high or rapidly rising rates:
Women: Experienced the largest proportional rise in alcohol-related deaths overall, with rates increasing 2.5 times between 1999 and 2020. This trend may be linked to changing social norms, targeted marketing, and physiological differences that make women more vulnerable to alcohol’s effects on the liver, heart, and brain.
Young Adults: The 25 to 34 age group saw a nearly fourfold increase in alcohol-related deaths overall.
Older Adults: While young adults saw the steepest proportional rise, individuals aged 55 to 64 had both the highest overall death rates and the steepest rise in mortality rates across most age groups over the study period. Alcohol-associated cancer deaths were also highest among those 55 and older.
Indigenous Peoples: American Indian and Alaska Native communities faced the highest death rates from alcohol-associated liver disease, which nearly doubled from about 25 to 47 per 100,000 over the study period.
Asian and Pacific Islanders: This group experienced the steepest overall increase in alcohol-related deaths compared to other racial/ethnic groups, increasing 2.4 times.
Underlying Factors Contributing to the Rise
Experts point to a combination of factors driving this alarming trend:
Pandemic Impact: Increased drinking fueled by stress, isolation, and economic uncertainty during the COVID-19 pandemic significantly contributed, particularly to the spike in liver disease deaths.
Existing Health Conditions: High rates of obesity, diabetes, and pre-existing liver damage in the U.S. population accelerate liver damage caused by alcohol and worsen health outcomes.
Mental Health: Mental health challenges, including stress and depression, are strongly linked to increased alcohol use and exacerbated during the pandemic.
Social Norms & Marketing: Changing social norms, increased accessibility, and targeted marketing (including towards women) contribute to higher consumption levels.
Physiological Differences: Women’s increased vulnerability may be partly due to having less of the enzyme (alcohol dehydrogenase) that breaks down alcohol, potentially leading to faster progression to severe health consequences like cirrhosis and alcohol use disorder – sometimes referred to as a “telescoping” effect.
Regional differences were also observed, with the Midwest seeing the greatest jump in overall alcohol-related mortality and Washington, D.C., exhibiting the highest alcohol-related cancer death rate.
Addressing the Public Health Challenge
Healthcare providers are urged to recognize heavy alcohol use as a leading risk factor for premature death, including not only liver damage and certain cancers but also cardiovascular issues like heart attacks and stroke. Routine screening for alcohol use in primary care settings is critical. Experts emphasize that the amount of alcohol consumed significantly impacts mortality risk, stating that the difference between drinking small and moderate-to-large amounts could determine the difference between preventing and causing premature deaths.
These findings underscore the urgent need for tailored public health interventions, increased awareness campaigns about alcohol’s risks (including cancer), and enhanced support systems to address the growing impact of alcohol consumption on mortality rates across the United States.
