July 28, 2023—Women in the U.S. are dying of alcohol-related causes at a much faster rate than are U.S. men, according to a new study that tracked these deaths for 20 years. The most dramatic rise occurred in the last 3 years covered by the study.
“From 2018 to 2020, there was an increase of 14.7% per year” in alcohol-related deaths in women, said study researcher Ibraheem M. Karaye, MD, DrPH, assistant professor of population health, and director of the health science program at Hofstra University in Hempstead, NY. While alcohol-related deaths in men also increased greatly during that same 3-year period, it was less than in women, at 12.5% per year.
Researchers have known for several years that the sex gap related to alcohol use and complications is narrowing. Women are drinking more, engaging in more high-risk drinking, and increasingly developing alcohol use disorder, Karaye said. “However, we know very little about the trends in alcohol-related deaths.”
Using a CDC database that spanned the years 1999 to 2020, Karaye and his co-researchers analyzed files that identified underlying causes of death. During those years, more than 605,000 alcohol-attributed deaths were identified. Overall, men were still nearly three times more likely to die from alcohol-related issues than women were. However, the rate of alcohol-related deaths in women increased steadily and, in the latest years studied, more greatly than in men.
“We found there were three different segments of trends in women,” Karaye said. The rates increased slowly, then steadily picked up speed. For instance:
- 1999-2007: “We found that mortality rates from alcohol were increasing by 1% per year” in women, he said.
- 2007-2018: “The rate increased 4.3% per year. That was a big one, but not as phenomenal as the most recent, the most concerning,” he said.
- 2018 to 2020: The rate increased 14.7% per year in women compared to 12.5% per year for men.
The findings stayed strong, Karaye said, even when the researchers excluded data from the year 2020, the first pandemic year.
Explaining the Increase
“Our study is descriptive; it tells us the ‘what’ but not the ‘why,’” Karaye said. "However, we can speculate based on what’s known and previous research.” Women are drinking at higher rates than before and tend to develop more alcohol-related complications than men do.
Women have lower concentrations of the enzyme called alcohol dehydrogenase, which helps breaks down and metabolize alcohol. “We know that in women the concentration of fat to water is higher, so that also leads to a possibly higher concentration of alcohol,” Karaye said.
The study findings point to the need for more research to focus on causes for the rise in women, Karaye said. Studies on the use of medication for alcohol use disorder need to represent women more equitably, he said.
Other Findings on Women, Alcohol
Other recent research has found that the proportion of suicides that involved alcohol has also increased for women of all age groups, but not men. In research published in 2022, researchers analyzed more than 115,000 deaths by suicide from 2003 to 2018 and found the proportion of those deaths involving alcohol at a level above the legal limit increased annually for women in all age groups, but not for men.
A review by Mayo Clinic researchers found that women are increasingly affected by liver disease linked to alcohol and develop more severe disease at lower levels of drinking than do men. Among other factors, the researchers said that an increase in obesity, which can worsen the liver-damaging effects of alcohol, is a contributor.
Expert Perspectives
Overall, recent research is showing that “not only are women drinking more but potentially are developing more problems later on as a result of the alcohol,” said Mark S. Kaplan, DrPH, professor emeritus of social welfare at the UCLA Luskin School of Public Affairs. He conducted the study finding growing alcohol use involvement in women’s death by suicide.
“I think this new study is strong,” he said. In future research, “we should focus on some of the issues that may have to do with social circumstances.”
In particular, he said, research should examine the increase in alcohol-involved death found in the new study among American Indian or Alaska Native women. While the overall annual increase was 14.7% for the years 2018-2020, the rate among American Indian or Alaska Native women was 22.8% annually.
While the new study and others find the gap between the sexes is narrowing for alcohol-related complications, “unfortunately, alcohol use disorder and alcohol-related deaths are increasing in both men and women,” said Camille A. Kezer, MD, a gastroenterology and hepatology fellow at Mayo Clinic, who led the review on sex differences in alcohol-linked liver disease.
However, she said, “we know that there are risks of alcohol that are unique to women for a variety of reasons, including differences in metabolism and the impact of hormones, as well as the increasing prevalence of obesity and bariatric surgery in women.”
Bariatric surgery has been linked with an increase in alcohol consumption and disorder in some studies.
Kezer’s advice to women: “Limit alcohol intake to one drink per day or less. If you are concerned about your alcohol intake, you should seek help.”
Health care providers are committed to helping their patients recognize and treat alcohol-related disorders, she said.
