Excessive alcohol consumption causes more than 100,000 deaths annually in the United States, and
although the number shows little sign of declining, the rate per 100,000 population has trended down
since the early 1980s. Accidents, mostly due to drunken driving, accounted for 24 percent of these
deaths in 1992. Alcohol-related homicide and suicide accounted for 11 and 8 percent respectively.
Certain types of cancer that are partly attributable to alcohol, such as those of the esophagus,
larynx, and oral cavity, contributed another 17 percent. About 9 percent is due to alcohol-related
stroke. One of the most important contributors to alcohol-related deaths is a group of 12 ailments
wholly caused by alcohol, among which alcoholic cirrhosis of the liver and alcohol dependence
syndrome are the most important. These 12 ailments together accounted for 18 percent of the total
alcohol-related deaths in 1992. Mortality due to the 12 causes rises steeply into late middle age
range and then declines markedly, with those 85 and over being at less than one-sixth the risk of 55
to 64-year olds.
The most reliable
data are for the
12 conditions
wholly attributable
to alcohol. The
map shows these
data for all people
35 and over. The
geographical
distribution for
men and women
follows much the
same pattern,
although men are
three times as
likely to die of one
of the 12
alcohol-induced
ailments. The
geographical
distribution for
whites and blacks
follows roughly
the same pattern
but the rates for blacks are two and half times higher. In the late nineteenth century blacks, who
were then far more abstemious than whites, were strong supporters of the temperance movement,
but the movement in the South was taken over by whites bent on disenfranchising black people by
any means possible, such as propagating lurid tales of drink-crazed black men raping white women.
Consequently, blacks became less involved in the temperance movement, a trend that accelerated
early in the twentieth century with the great migration of blacks to the North, where liquor was
freely available even during Prohibition.
The geographical pattern of mortality from the 12 conditions wholly caused by alcohol is partly
explained by the average alcohol consumption among those who drink, which tends to be higher in
the Southeast certain areas of the West and than elsewhere. In New Mexico, Arizona, Alaska, and
in many counties in the Plains and Mountain states, the rates are high, in part, because of heavy
drinking among Native Americans. Another possible contributor to high rates in the West is lower
family and community support than elsewhere, as suggested by high divorce and suicide rates, low
church membership, and the large number of migrants from other regions. In the South Atlantic
states, black males contribute heavily to the high mortality rates, although white rates there are
above average. One unexplained anomaly is the comparatively low rates in the area stretching from
Kentucky through Tennessee, Alabama, Mississippi, to Louisiana, all states with high alcohol
consumption among those who drink.
There were at least four cycles of high alcohol consumption
in the last 150 years with peaks in the 1840s, in the 1860s,
the first decade of the twentieth century, and again in the
1970-1981 period. Each of these peaks was probably
accompanied by an increase in alcohol-related deaths, as
suggested by the course of liver cirrhosis mortality, which,
since the early twentieth century, has followed more-or-less
the same trend as consumption of beverages alcohol. (Up to
95 percent of liver cirrhosis deaths are attributable to
alcohol.) America is now in a phase of declining alcohol
consumption, so one would expect that the rate of
alcohol-related deaths would continue to decline. Among
westernized countries, America in the early 1990s was
somewhat below average in both alcohol consumption and liver cirrhosis mortality.
Rodger Doyle Copyright 1996
Reproduced from Scientific American, December, 1996.
Reproduction not permitted except with permission.
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