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Current Trends Alcohol-Associated Premature Mortality -- United States, 1980

Alcohol abuse and alcohol-associated illnesses are major causes of premature mortality in the United States (1). Reducing the considerable morbidity and mortality related to alcohol misuse is one of the U.S. Public Health Service's 1990 Objectives for the Nation (2). Achievement of these objectives requires effective interventions targeted towards specific groups at particular risk of alcohol-related illness. Race- and sex-specific rates of years of potential life lost (YPLL) provide one mechanism for identifying these target population groups.

Use of the Multiple Cause of Mortality tapes from the National Center for Health Statistics allows a determination of premature mortality attributable to certain specific alcohol-associated conditions, where these conditions appear as either the underlying or contributing cause of death. Race- and sex-specific YPLL and rates per 100,000 population from selected causes are shown in Table 1.

Native Americans have the highest rate of YPLL due to each of these alcohol-associated causes of mortality, followed by blacks. In general, males of all races have a higher rate for each mortality cause than females. Native American females, however, have a higher rate of deaths attributable to alcoholic cirrhosis than either black or white males. Reported by D Bertolucci, MA, J Noble, M Dufour, MD, National Institute on Alcohol Abuse and Alcoholism, Rockville, Maryland; Epidemiologic Studies Br, Div of Surveillance and Epidemiologic Studies, Epidemiology Program Office, CDC.

Editorial Note

Editorial Note: The rate of alcohol-related YPLL parallels that of total YPLL from all causes in the United States, being higher in males than females (3). Similarly, the total rate of YPLL for all causes is lower in whites than in blacks and Native Americans. Unlike the total rate, however, where blacks have higher rates than Native Americans, the Native Americans in the United States have the highest rate of alcohol-associated YPLL. These data must be interpreted cautiously, since Native Americans are not a homogenous group.

These data include only YPLL for selected causes of mortality due to alcohol misuse. They do not include many other causes of death (e.g., alcoholic gastritis, alcoholic cardiomyopathy, motor vehicle-related and other injuries, suicide, and homicide) that are wholly or partially due to alcohol misuse (4). Second, physicians may significantly underreport alcohol misuse as an underlying cause of death on death certificates (5). More accurate measures of the proportion of premature mortality attributable to alcohol are needed. One way of increasing reporting accuracy is for physicians to record excessive blood alcohol concentration, International Classification of Diseases, 9th Revision, code 790.3, as an underlying or contributory cause of death where appropriate.

Targeting groups at high risk of premature death from alcohol misuse for education and other interventions may provide the greatest benefit in reducing alcohol-associated premature mortality in the United States. Finally, accurate monitoring systems of alcohol-associated mortality in states will provide important outcome measures of the effectiveness of various state and community intervention programs.

References

  1. CDC. Surveillance and assessment of alcohol-related mortality--United States, 1980. MMWR 1985;34:161-3.

  2. U.S. Department of Health and Human Services. Promoting health/preventing disease: objectives for the nation. Washington, D.C.: U.S. Public Health Service, Department of Health and Human Services 1980:67-72.

  3. CDC. Unpublished data.

  4. Research Triangle Institute. Economic costs to society of alcohol and drug abuse and mental illness: 1980. Research Triangle Park, North Carolina: Research Triangle Institute 1984:46-8.

  5. Dufour M, Malin H, Bertolucci D, Christian C. Death certification practices in alcohol-related traffic fatalities. 112th annual meeting, American Public Health Association, Anaheim, California, November 1984.



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