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 Unpublished data.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