US deaths related to alcohol use disorder (AUD) topped expectations for the second year in a row, with younger adults seeing the steepest increases, a cross-sectional study of CDC data indicated.
In 2021, deaths where AUD was listed among multiple causes were 22% higher than projected (20.0 vs 16.4 per 100,000) and 28.8% higher in cases where AUD was listed as the underlying cause (6.4 vs 5.0 per 100,000), according to researchers led by Yee Hui Yeo, MD, MSc, of Cedars-Sinai Medical Center in Los Angeles, writing in JAMA Network Open.
“Physicians and frontline providers should recognize the uprising trend of alcohol use, withdrawal, and mortality,” Yeo told MedPage Today by email. “During the pandemic, healthcare delivery for individuals with AUD was substantially shattered.”
The researchers reported similar findings for 2020, with AUD-related deaths 24.8% higher than projected based on trends from the prior eight years (19.7 vs 15.8 per 100,000) and 30.7% higher in cases where AUD was listed as the underlying cause (6.2 vs 4.8 per 100,000).
And while all subgroups saw increases in AUD-related deaths during the pandemic, the youngest studied (those ages 25 to 44) experienced the greatest increases (40.47% in 2020 and 33.95% in 2021).
In both the inpatient and outpatient settings, physicians need to focus on reversing the widening gaps in the cascade of care for people with AUD, urged Yeo.
“A big wave of AUD-related complications (liver diseases, mental health issues, etc.) are surging now due to the loss to follow-up, progressive disease, or misdiagnosis during the pandemic, and we are not well prepared,” he said.
Yeo noted that lower socioeconomic status, reduced access to healthcare, and medical noncompliance are not uncommon among individuals with AUD, and these factors and hurdles should be recognized in order to best provide care. He added that while the pandemic brought about a surge in telemedicine, its effective use among people with AUD and the “compliance and attrition using telemedicine remain unknown.”
For their study, the researchers examined 343,384 AUD-related deaths from 2012 to 2021 using de-identified data from CDC’s National Vital Statistics System and the Wide-Ranging Online Data for Epidemiologic Research (WONDER) database. Of these deaths, 56.0% were in adults ages 45 to 64 years, 27.4% in people 65 and older, and 16.6% in those ages 25 to 44.
AUD-related deaths rose steadily from 2012 to 2019, both when AUD was listed among multiple causes (from 10.6 to 15.1 per 100,000, respectively) or when listed as the underlying cause (from 3.1 to 4.6 per 100,000).
Over three-fourths (77.7%) of the deaths during the 10-year study period involved men, but increases in AUD-related deaths were similar for both men and women. For example, women in 2021 had an increase of 20.1% over what was projected (8.9 vs 7.4 per 100,000).
Only 10% of the deaths seen in the study were COVID-related, the authors noted, suggesting “that excess deaths were more likely attributable to indirect effects of the pandemic such as stay-at-home policies and reduced medical and social resources for patients with AUD.”
Limitations cited by the authors included the potential for misclassification in death certificates, though they noted that AUD is typically underrecognized.
Yeo had no disclosures. One co-author reported relationships with Gilead and Merck Sharp & Dohme.