Alcohol-induced deaths in the United States across age, race, gender, geography, and the COVID-19 pandemic.

We analyze alcohol-induced deaths by race, gender, age and geography on a yearly (1999-2024) and monthly (2018-2024) basis, using data from the National Vital Statistics System. Crude rates for alcohol-induced deaths increased by 89% from 1999 to 2024. The largest relative increase occurred among females aged 25-34, with a 255% increase, and males aged 25-34, with a 188% increase. American Indian and Alaska Native populations remain the most affected. While alcohol-induced deaths are higher among males, crude rates are rising faster among females across all demographics, a concerning trend. Sharp increases occurred at the onset of COVID-19, peaking in 2021. For most demographics across the nation, crude rates remained abnormally high throughout 2023; significant decreases emerged only in 2024, four years after the start of COVID-19. Females were more impacted by alcohol-related liver disease than males; alcohol-related mental and behavioral disorders affected both genders. The largest monthly increases in alcohol-induced deaths occurred in American Indian and Alaska Native males (41% increase between May and June 2020) and females (32% increase between June and July 2020), Black females (32% increase between April and May 2020), males aged 15-34 (28% increase between April and May 2020) and females aged 35-44 (28% increase between April and May 2020). Since 2010, the highest crude rates have been in New Mexico. Record increases occurred in all states between 2019 and 2021; the largest was in Mississippi (122% increase between 2019 and 2021). By 2024, rates had returned within 10% of their 2019 levels in about half the states. In Oglala Lakota County (SD), McKinley County (NM), and Apache County (AZ), crude rates have exceeded an astonishing 80 fatalities per 100,000 annually since 2020. These findings emphasize the urgent need for targeted policies to reduce excessive alcohol consumption and improve access to treatment.