Racial and Ethnic Disparities in Alcohol Consumption and Mortality in the U.S

Abstract

Introduction: Although there are racial/ethnic differences in alcohol use, there is little information about differences in mortality from all alcohol-related conditions or by cause of death. Furthermore, little is known about the degree to which racial/ethnic differences in mortality persist after adjusting for ethanol consumption. The purpose of this cross-sectional study was to comprehensively assess racial/ethnic differences in alcohol-attributable deaths and reduced life expectancy.

Methods: Alcohol prevalence data were from the Behavioral Risk Factor Surveillance System, and mortality data were from the National Vital Statistics System. Alcohol-attributable fractions and the Alcohol-Related Disease Impact application were used to assess alcohol-attributable deaths from 58 partially or wholly alcohol-attributable conditions in the U.S. during 2020-2021 (analyzed in 2024).

Results: White persons (60.9% of the population) accounted for 70.8% of all alcohol-attributable deaths and had the second-highest death rate (63.8 per 100,000) among racial/ethnic groups. American Indian/Alaska Native persons had the highest alcohol-attributable death rate (145.3) and the lowest average age of death (48.1 years). White and Asian, Native Hawaiian, or Pacific Islander persons tended to die of alcohol-attributable conditions from chronic diseases at relatively older ages, whereas people in other racial/ethnic groups tended to die at younger ages from alcohol-attributable acute causes of death. After adjusting for differences in per capita alcohol consumption, there remained fourfold differences in alcohol-attributable deaths by race/ethnicity.

Conclusions: Large differences in alcohol-attributable deaths across racial/ethnic groups were only partially explained by racial/ethnic differences in alcohol consumption. Implementing effective alcohol policies and addressing social determinants of health could reduce alcohol-related harms across race/ethnicities.