Study finds stark racial and ethnic disparities in alcohol-induced mortality among US adults during the pandemic

Reviewed by Danielle Ellis, B.Sc.Jun 21 2023

Alcohol-related deaths rose disproportionately quickly in the US among Black, Hispanic, Asian and American-Indian/Alaska Native populations at the start of the COVID-19 pandemic, new research shows.

Detailed in The American Journal of Drug and Alcohol Abuse, the peer-reviewed analysis of official data revealed that while the rate of deaths that can be directly attributed to alcohol increased sharply overall, there were stark ethnic and racial disparities.

"Racial and ethnic minority groups experienced disproportionately higher rates of unemployment, fear of Covid and financial strain during the pandemic," says lead author Dr Hyunjung Lee, who carried out the research whilst at the John McCormack Graduate School of Policy and Global Studies, University of Massachusetts Boston.

"We also know that American Indian and Alaska Native populations, Black Americans and Hispanics have historically experienced higher alcohol-induced mortality rates and so we thought it was important to examine how the pandemic might have affected these rates."

The biggest increase witnessed by Dr Lee and co-author Dr Gopal Singh, from The Center for Global Health and Health Policy, Global Health and Education Projects, Inc., Riverdale, Maryland, was in American Indian and Alaska Native populations, where the proportion of deaths that could be directly attributed to alcohol more than doubled between February 2020 and January 2021.

This was followed by 58% increase in the rate of alcohol-related deaths in Black Americans, a rise of 56% in Hispanic Americans and a 44% increase in Asian Americans. The non-Hispanic White population experienced a 39% rise. This is surprising because another study found that alcohol consumption rates similarly increased among racial/ethnic groups during the pandemic– yet the death rates differed.

In the first study of its kind, Dr Lee, who is now with the Cancer Disparity Research Team, Surveillance & Health Equity Science Department, American Cancer Society, Atlanta, Georgia, and Dr Singh used death records and census data to calculate alcohol-induced death rates in adults aged 25-plus in each month from January 2018 to December 2021.

They looked at how the rate changed overall, as well as by age, sex, race and ethnicity.

There were 178,201 deaths with alcohol as the underlying cause during this 4-year time period. Liver cirrhosis accounted for almost half of these deaths; alcohol-related mental health problems and accidental poisoning by alcohol were the second and third most common causes of death.

Among those aged 25 and over, alcohol-related deaths overall rose by 25.7% between 2019, when there were 38,868 deaths and 2020, the first year of the pandemic, when there were 48,872 deaths.

Data from 2020 shows that the increase in alcohol-related deaths was far from uniform, with marked disparities by sex and age, as well as race by and ethnicity.

The death rate rose more quickly in females, although males still accounted for the bulk of deaths.

Similarly, alcohol-related deaths climbed more sharply among younger people, with a 78% rise among 35 to 44-year-olds and 68% rise in the alcohol-induced death rate in 25 to 34-year-olds.

It is possible that these age groups felt the effects of school closures and job losses more keenly than older people who were more financially secure and had fewer childcare responsibilities.

The study's authors describe the disproportionate increase in deaths among Black, Hispanic, Asian and American-Indian/Alaska Native (AIANs) populations as being particularly concerning.

The authors speculate: "The psychological and financial strains of the pandemic, combined with the deprioritizing of alcohol use disorder treatment during Covid-19, might have exacerbated existing disparities in sociodemographic characteristics and access to care. This could have accelerated alcohol-related deaths, creating the stark disparities in increases in death rates revealed by our analysis."

Existing disparities from other research include higher rates of severe anxiety, stress or depression in AIANs. They also have the highest disability, unemployment and poverty rates in the US. Hispanic Americans, meanwhile, are less likely to use specialist alcohol treatment than other groups.

Dr Lee and Dr Singh conclude by calling for policies to improve access to treatment for alcohol disorders. They would also like to see educational programs on the health harms of alcohol to be designed for, and targeted at, groups with sociocultural and linguistic barriers.

The study's limitations include using provisional death data for 2021. Although the latest information available at the time, it may have been lower than the final figures. In addition, misclassification of AIANs, Asian Americans and Hispanic Americans on death certificates could have led to the disparities in alcohol-related deaths being underestimated.