Increasing spirits use and alcohol-related mortality in the US: Analyses of mortality rate relationships with beverage-specific per capita consumption and policies

Overview: Establishing and quantifying the population impacts of total and beverage-specific alcohol consumption on mortality outcomes and estimating beverage-specific alcohol policy impacts on consumption and mortality will provide more complete and up-to-date evidence needed to determine the strength and beverage-specificity of price and availability policies. Findings are expected to support increasing alcohol taxes and reducing availability while maintaining or increasing stronger spirits policies to reduce population alcohol consumption and related mortality, improving the health of the American population.

Mortality and morbidity from alcohol-related causes has increased dramatically since 1999 and particularly since 2010 with additional steep increases seen during 2020 and 2021. Differential mortality rate changes by sex, age and educational attainment group have occurred.

This project provides new analyses of alcohol-related mortality in the US needed to understand and address these changes. Analyses will focus particularly on per capita consumption (PCC) of spirits, which has also risen steeply during the same period and have been previously found to be more strongly linked to alcohol-related deaths than beer or wine. Mortality cause groups include all-cause, 100% alcohol-attributable causes, cirrhosis, suicide, motor vehicle accidents, other unintentional injuries, ischemic heart disease, dementia and cancers.

Analyses will also make use of the more detailed information available on death certificates in ICD-10 since 1999 to consider scientifically justified subgroup differences in alcohol consumption and policy impacts on mortality rates, which could not be estimated in earlier data.

Aim 1 will address state-level beverage PCC and subtype trends documenting state differences. Aim 2 will update the US literature on associations between total and beverage-specific PCC and mortality rates by cause group, where there have been stronger relationships with spirits PCC for some causes and extend these analyses to consider sex-specific subpopulations, such as educational attainment groups, where scientifically justified. In Aim 3 we will address the understudied issue of policies that differentiate between beverage types, specifically considering more recent tax increases only on spirits and policies increasing availability of spirits, specifically into grocery stores.

Analyses will also utilize new estimates of state tax rates that include spirits control states for the first time in 1968-2024 state panel models of policy effects on alcohol-related mortality causes. State policy environments will be classified in terms of more restrictive treatment of spirits and analyses will consider differential impacts of total and beverage-specific PCC on mortality rates across the classified groups.

Although national and state alcohol policies nearly always include higher tax rates and more restrictions on spirits sales, there is a lack of consensus among researchers and policy experts regarding this important issue. Together, these analyses will provide up-to-date evidence of alcohol’s impact on mortality with attention to beverage types and scientifically-justified population subgroups, evidence of the effectiveness of specific spirits-focused policies and of a policy environment targeting spirits. Hypothesis testing will focus on expectations of stronger associations between spirits PCC and mortality causes and effectiveness of specific spirits-focused policies. If hypotheses are supported, US policymakers, researchers and community members will have timely research findings to support the strengthening of alcohol policies such as increasing taxes and reducing access to alcohol by keeping spirits and RTDs out of grocery stores.