ARDI FAQ (Frequently Asked Questions)

ARDI Information

General Information on the Alcohol-Related Disease Impact Application

Why are the ARDI estimates important?

The Alcohol-Related Disease Impact (ARDI) application generates estimates of alcohol-attributable deaths (AAD) and years of potential life lost (YPLL) due to alcohol consumption. These estimates provide vital information to better understand the health consequences of excessive alcohol use in the United States. In addition to estimating the national health effects of alcohol consumption, the ARDI application can produce state estimates of AAD and YPLL. Such state-specific analyses are useful because the prevalence of excessive alcohol use, particularly binge drinking, is known to vary substantially by location. State-specific estimates of alcohol-related health outcomes can better focus discussions of evidence-based public health strategies (e.g., increasing alcohol taxes, regulating the density of alcohol outlets, and alcohol screening and brief intervention) aimed at preventing consequences associated with excessive alcohol use.

Who is the intended audience for ARDI?

The primary audience for ARDI is state governments, particularly state health departments and state substance abuse agencies interested in determining the health impact of excessive alcohol use in their state for prevention, policy, and informational purposes. In addition, academic researchers will also benefit from using the ARDI application to estimate alcohol-attributable deaths (AAD) and years of potential life lost (YPLL) for research and analysis purposes.

The secondary audience includes those organizations involved with alcohol-related prevention and treatment programs, as well as state health policy organizations. These organizations include, but are not limited to, health-related nonprofit organizations, primary care associations, advocacy groups, as well as local boards of health, and city and county health departments.

Can ARDI be used to evaluate the effectiveness of public health programs?

ARDI is designed to estimate the health effects of excessive alcohol consumption over a specified period of time (e.g., an average over a 5-year period). Therefore, these estimates are not intended to be used to evaluate the effectiveness of public health programs or policies aimed at reducing alcohol consumption. Furthermore, these estimates are subject to year-to-year variations, which although reduced by using multiple years of data, are still subject to anomalies in the collection of mortality data that may not reflect changes in actual alcohol consumption resulting from public health programs.

Can ARDI be used to study trends over time in alcohol-attributable deaths (AAD) or years of potential life lost (YPLL)?

The ARDI application is used to assess average AAD or YPLL over a specified period of time, usually 5 years. The application is not set up to examine trends in AAD or YPLL over time mainly because of the year-to-year variations in these estimates that may not be due to alcohol consumption.

Can I compare ARDI estimates published by CDC over the years to determine if the number of alcohol-attributable deaths has changed over time?

No, the estimates may not be comparable because CDC continues to improve the ARDI application and periodically updates the methods for calculating the average annual number of alcohol-attributable deaths nationally and in states. These changes are documented in the Announcements with each release of ARDI. For example, a new methodology was used with the release of ARDI estimates in 2022 to account for the under-reporting of alcohol use. The data show that the average annual number of alcohol-attributable deaths during 2015–2019 was approximately 140,000 deaths. If the same methods are applied to the previous data for 2011–2015, the average annual number of alcohol-attributable deaths during those years was approximately 121,000 deaths.

Can ARDI be used to compare my state’s alcohol-related outcomes to other states or national estimates?

The estimates provided in ARDI are the total number of alcohol-attributable deaths (AAD) or years of potential life lost (YPLL) for the location specified. To accurately compare states to each other or to national estimates, the AAD and YPLL must be adjusted appropriately to reflect differences in demographics between locations (e.g., regional differences in average age of the population). ARDI does not report adjusted AAD or YPLL; therefore, the estimates provided in the ARDI reports should not be compared across locations.

Can I obtain a breakdown of alcohol-attributable deaths (AAD) and years of potential life lost (YPLL) by race and ethnicity from ARDI?

No, the current version of ARDI is only able to stratify AAD and YPLL by sex and age.

At the top of the reports, why is there a note indicating that the numbers may not sum to total due to rounding?

Rounding affects the numbers in the reports on alcohol-attributable deaths and years of potential life lost in a few different ways so that they may not sum to the totals. The annual average number of total deaths from each condition is calculated for each 5-year age grouping by sex, using a decimal point. The total death numbers are rounded to the nearest whole numbers after the alcohol-attributable fractions or relative risks are applied for calculating the alcohol-attributable deaths. The estimated numbers of alcohol-attributable deaths and years of potential life lost by cause of death are calculated as whole numbers and presented by sex and age group, as well as by sex-specific age groups. The sum of estimates from stratified views may not sum to totals. Also, the sum of the estimates in the state reports may not equate to the US estimates because of: 1) rounding in the calculation of the alcohol-attributable deaths and years of potential life lost; and 2) use of state-specific indirect alcohol-attributable fractions for estimating alcohol-attributable deaths from most chronic causes. The US reports are generated based on the national-level annual average number of total deaths from each condition rather than as the sum of the state estimates of alcohol-attributable deaths and years of potential life.

Why are some estimates of alcohol-related deaths suppressed?

To protect confidentiality, data are suppressed in cells with an estimate of fewer than 10 deaths or in which presenting data would provide information to derive the estimate for another cell that has fewer than 10 deaths.

Why are beneficial effects associated with alcohol consumption reported for some causes but not for others?

Although alcohol is associated with increased all-cause mortality, alcohol consumption has been shown to reduce the risk of death from a limited number causes (e.g., gallbladder disease). For these causes, the relative risk estimates included in ARDI are less than one. When these estimates are used to calculate indirect alcohol-attributable fractions (AAF), the result is a negative AAF. When this negative AAF is then multiplied by the total number of deaths for that condition, the resulting number of deaths is negative. This indicates that there are net lives saved from alcohol use at a particular consumption levels (e.g., low average daily alcohol consumption) for these causes.

Why are alcohol-attributable deaths (AAD) and years of potential life lost (YPLL) among people younger than 21 years described as being caused by “exposure” to alcohol?

The term “exposure” is used to describe AAD and YPLL for people younger than 21 years because deaths in this age group may result from an individual’s own drinking, or from the second-hand effects of someone else’s drinking (e.g., deaths from riding in a vehicle with an alcohol-impaired driver). Some causes of death in ARDI specifically affect infants and children (e.g., child maltreatment, fetal alcohol syndrome, and low birth weight) are entirely the result of another person’s (e.g., the infant’s mother’s) drinking. Therefore, because the AAD and YPLL included people who were younger than 21 in the attributable to alcohol exposure category, many of them are due to someone else’s alcohol consumption.

How often are the data updated in ARDI?

Default data on deaths by cause, life expectancy, and prevalence of alcohol consumption are updated periodically to reflect newly available mortality estimates. Risk estimates and alcohol-attributable fractions (AAF) are re-examined periodically as new scientific estimates become available.

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Alcohol-Attributable Fractions (AAF)

What are alcohol-attributable fractions (AAF)?

Alcohol-attributable fractions (AAF) are used to express the extent to which alcohol consumption contributes to a health outcome. In ARDI, AAF measure the total proportion of deaths from various causes that are directly or indirectly attributable to alcohol consumption.

How are alcohol-attributable fractions (AAF) calculated?

Information on the calculations of the AAF used in ARDI can be found in the Methods section.

Why is the Fatality Analysis Reporting System (FARS) used to obtain alcohol-attributable fractions (AAF) for motor-vehicle crash deaths?

The Fatality Analysis Reporting System (FARS), which is administered by the National Highway Traffic and Safety Administration, provides annual estimates of alcohol involvement for all traffic crashes that occurred on US roadways in a given year. The FARS protocol for determining alcohol involvement in a crash also makes it possible to calculate age-specific AAFs by state. Therefore, FARS is considered the best and most timely source of AAF for motor-vehicle traffic crash deaths.

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Prevalence of Alcohol Consumption

How does ARDI determine the prevalence of alcohol consumption to calculate indirect estimates of alcohol-attributable fractions (AAF)?

The prevalence of alcohol consumption, measured as the average number of drinks consumed per day, is estimated using self-reported information on alcohol consumption from the CDC’s Behavioral Risk Factor Surveillance System (BRFSS). The BRFSS includes four questions on the core survey about alcohol use in the past 30 days: the frequency of drinking days, the quantity of drinks consumed on drinking days, the frequency of binge drinking, and the largest number of drinks consumed on any occasion. The total quantity and frequency of drinking is combined to estimate the average amount of alcohol consumed per day. The ARDI application adjusts the prevalence of low, medium, and high average daily alcohol consumption to account for the underreporting of self-reported alcohol consumption in the BRFSS using per capita alcohol sales data. More detailed information regarding the calculation of average daily alcohol consumption and the cut-points used in calculating indirect AAFs are explained in the ARDI Methods section under Prevalence Data.

Can prevalence data from other sources besides the CDC’s Behavioral Risk Factor Surveillance System (BRFSS) be used to determine the prevalence of alcohol consumption?

The Custom Data section of ARDI allows users to enter their own mortality and prevalence data. Prevalence data can be used from surveys other than the BRFSS as long as questions regarding both the quantity and frequency of alcohol consumption are used and the survey is administered to a representative sample for the location.

Why are there several different sets of prevalence cut-points for alcohol consumption listed in ARDI, and how do I know which one is used to calculate alcohol-attributable fractions (AAF) for a given condition?

ARDI uses several meta-analyses to obtain the risk estimates for various chronic causes of death included in the application. For many causes, the prevalence cut-points for defining levels of alcohol consumption are determined by the authors of these analyses. For causes in which the study authors illustrated the relative risks on a continuous curve, standardized cut-points are used in ARDI and the relative risks were calculated for the midpoint of these standardized levels of alcohol consumption. The cut-points for defining the levels of alcohol consumption for each condition assessed using indirect AAFs are included in the Methods section.

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Alcohol-Attributable Deaths (AAD)

How were the alcohol-related causes of death included in ARDI selected?

The Centers for Disease Control and Prevention (CDC) convened a scientific work group composed of experts on alcohol and health to guide the development of the earlier version of the ARDI application. One of the group’s tasks was to select alcohol-related causes of death using conditions that were previously examined in meta-analyses. Some causes (e.g., tuberculosis, HIV, and hepatitis C) were not included in ARDI because suitable pooled relative risk estimates or alcohol-attributable fractions (AAF) were not available. More recently, CDC convened another scientific work group to update the list of conditions included in ARDI, the AAFs for deaths from these conditions, and the ICD-10 codes used for defining deaths from these conditions.

How do I know if a cause of death is alcohol-attributable?

ARDI currently includes a list of 58 causes of death with enough scientific evidence to show alcohol-attribution. The ICD codes associated with these deaths are found at Alcohol-Related ICD Codes. ARDI uses the underlying cause of death listed on death certificates to determine if the death was alcohol-attributable.

Does ARDI calculate the number of deaths due to binge drinking?

The studies that were used to obtain alcohol-attributable fractions for the acute causes of death (e.g., injuries) included in the ARDI application defined a death as being alcohol-attributable if the decedent, or another person who was responsible for a death (e.g., the driver of a vehicle in a fatal motor vehicle crash), had a blood alcohol concentration (BAC) greater than or equal to 0.10 g/dL at the time of death for deaths from injuries other than motor vehicle traffic crashes, or a BAC greater than or equal to 0.08 g/dL at the time of death for deaths from motor vehicle traffic crashes.

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User Help

Who do I contact if I am having problems with the site?

Please contact us through the online form.

How do users cite ARDI as a reference/resource in publications?

Please use the following citation for ARDI if using the data in publication:

Centers for Disease Control and Prevention. 2022 Alcohol Related Disease Impact (ARDI) Application website. www.cdc.gov/ARDI. Accessed [Date].

Can I use ARDI to calculate economic impacts related to alcohol use?

No. This feature is not available in the current version of the ARDI application.

Where can I find more information on the health and social impacts of alcohol consumption?

More information on the health and social impacts of alcohol consumption is available at the CDC’s Alcohol and Public Health website and at the CDC Alcohol Portal.

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User Help

Who do I contact if I am having problems with the site?

Please contact us through the online form.

How do users cite ARDI as a reference/resource in publications?

Please use the following citation for ARDI if using the data in publication:

Centers for Disease Control and Prevention. 2022 Alcohol Related Disease Impact (ARDI) Application website. www.cdc.gov/ARDI. Accessed [Date].

Can I use ARDI to calculate economic impacts related to alcohol use?

No. This feature is not available in the current version of the ARDI application.

Where can I find more information on the health and social impacts of alcohol consumption?

More information on the health and social impacts of alcohol consumption is available at the CDC’s Alcohol and Public Health website and at the CDC Alcohol Portal.

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