Trends in Mortality from Cirrhosis and Alcoholism -- United States, 1945-1983

Approximately 10.6 million adults in the United States can be classified as alcoholics, and an additional 7.3 million either are alcohol abusers or have experienced negative consequences of alcohol use such as arrest or involvement in an accident. In addition, an estimated 4.6 million young people aged 14 to 17 are problem drinkers. The public health consequences of problem drinking include injuries and deaths from fires, falls, drowning, homicide, suicide, family abuse and other violence as well as industrial and motor vehicle accidents. An estimated one-third to one-half of all unintentionally and intentionally injured adult Americans involved in accidents, crimes, and suicides had been drinking alcohol (1,2). Problem drinking also causes medical damage including pancreatitis, nutritional deficiencies, malignancies, fetal alcohol syndrome, and cirrhosis (the ninth leading cause of death among adults in the United States) (3). Recent trends in the occurrence of selected medical complications of alcohol use are outlined below.

Since 1950, noticeable trends in selected mortality rates have been associated with alcoholism and alcohol abuse (Table 1) (4-9). The age-adjusted total cirrhosis death rate increased gradually from 1950 until 1973 and has since declined. Death rates due to alcoholism reached a peak in 1980 and have leveled off since then.

Per capita rates of alcohol consumption rose approximately 21% during the 1960s and 10.3% during the 1970s. Data from 1977 through 1984 (the latest year for which complete data are available) show that overall per capita consumption reached a plateau in 1980 and 1981 and then declined until 1984. The 1984 consumption rate, which approximated that of 1977, was estimated at 2.65 gallons of absolute ethanol per year for U.S. residents aged 14 or older.*

The trends in death rates from alcoholism and per capita alcohol consumption have been parallel. On the other hand, cirrhosis mortality rates have declined since 1973, while per capita consumption of alcohol continued to increase until 1982. Reported by J Colliver, PhD, D Doernberg, MLS, B Grant, PhD, Alcohol Epidemiologic Data System, CSR, Inc, M Dufour, MD, MPH, D Bertolucci, MA, Div of Biometry and Epidemiology, National Institute on Alcohol Abuse and Alcoholism; Epidemiology Br, Div of Nutrition, Center for Health Promotion and Education, CDC.

Editorial Note

Editorial Note: The reason for the decline in cirrhosis mortality since 1973 is not clear--especially since deaths from alcoholism and per capita consumption have not shown a similar decline. Possible reasons for this decrease include earlier diagnosis and improvement in medical management, which enable persons having the disease to live longer. In addition to improved medical care, other possible contributing factors include: changes in physicians' coding of death certificates, a decrease in causes of cirrhosis other than alcohol misuse, and a decrease in co-morbid conditions with a resultant increase in survival. If this is true, the decline in the cirrhosis mortality rates may not reflect changes in drinking habits of the general population, and per capita consumption may not directly reflect individual use patterns. Therefore, changes in the prevalence of chronic heavy alcohol use among certain segments of the population might not be seen.

Data from CDC's 1981-1983 behavioral risk factor surveys provided national estimates of the prevalence of three patterns of alcohol misuse: chronic heavy alcohol use--8.7%, binge drinking--22.7%, drinking and driving--6.1% (10,11) . The behavioral risk factor surveillance system (12) will be used to follow secular trends in these patterns of alcohol misuse and may provide some insight into changes in alcohol-related mortality as reflected by death certificate data. Further research is needed to determine which factor(s) account for the decline in cirrhosis mortality.

References

1. Office of the Secretary. Fifth special report to the US Congress on alcohol and health from the Secretary of Health and Human Services. Rockville, Maryland: Department of Health and Human Services, 1984. DHHS publication no (ADM) 84-1291.

2. Colliver J, Malin H. State and national trends in alcohol-related mortality. Alcohol Health and Research World 1986;3(10):60-4,75.

3. National Center for Health Statistics. Advance reporting of final mortality statistics, 1983. Hyattsville, Maryland: National Center for Health Statistics, 1985. (Monthly vital statistics report; vol 34; no 6; suppl 2).

4. National Center for Health Statistics. Vital statistics of the United States: volume II (data for years 1945-1980). Hyattsville, Maryland: National Center for Health Statistics, (Vol I and Vol II for each year, covering the years 1945-1980).

5. National Center for Health Statistics. Personal communication with Division of Vital Statistics, May 1986.

6. National Institute on Alcohol Abuse and Alcoholism. US alcohol epidemiologic data reference manual, Volume 2: liver cirrhosis mortality in the United States. Rockville, Maryland: National Institute on Alcohol Abuse and Alcoholism, 1985.

7. National Institute on Alcohol Abuse and Alcoholism. US alcohol epidemiologic data reference manual, Volume 3: county problem indicators. Rockville, Maryland: National Institute on Alcohol Abuse and Alcoholism, 1985.

8. Grant B, Zobeck T. Surveillance report #3: liver cirrhosis mortality in the United States, 1970-1983. Rockville, Maryland: National Institute on Alcohol Abuse and Alcoholism, 1986.

9. CDC. A system to convert ICD diagnostic codes for alcohol research. MMWR 1984;33:216, 221-3.

10. Marks JS, Hogelin GC, Gentry EM, et al. The behavioral risk factor surveys: I. state-specific prevalence estimates of behavioral risk factors. Am J Prev Med 1985;1(6):1-8.

11. Bradstock MK, Marks JS, Forman MR, Gentry EM, Hogelin GC, Trowbridge FL. The behavioral risk factor surveys: III. Chronic heavy alcohol use in the United States. Am J Prev Med 1985;1(6):15-20.

12. CDC. Behavioral risk-factor surveillance in selected states--1985. MMWR 1986;35:441-4.

*Estimated per capita ethanol consumption rates are based on beverage sales or shipments, and data include nondrinkers. Gallons of absolute ethanol consumption were calculated by using the following percentages of total beverage sales during the period 1945-1984: 1) For beer, 4.5% was used for the entire period; 2) for wine, 18.0% was used through 1951, 17% was used for the period 1952-1968, 16.0% was used for the period 1969-1971, 14.5% was used for the period 1972-1976, and 12.9% was used for the period 1979-1984; and 3) for spirits, 45.0% was used through 1971, 43.0% was used for the period 1972-1976, and 41.1% was used for the period 1977-1984.

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