Surveillance and Assessment of Alcohol-Related Mortality --
United States, 1980
Reduction of morbidity and mortality associated with misuse of
alcohol is a major target of the 1990 objectives for the nation
(1).
Recently available Multiple Cause of Mortality tapes from the
National
Center for Health Statistics (NCHS) represent a tool for more
comprehensive surveillance and assessment of alcohol-related
mortality
(2). National multiple-cause data tapes for 1980 were analyzed to
(1)
evaluate completeness of mortality reporting by comparing counts of
alcohol-related mortality recorded as the underlying cause with
those
recorded as contributing causes on the death certificate* and (2)
estimate premature mortality resulting from alcohol misuse.
Alcohol-related mortality attributable to specific diagnoses
has
been recorded on death certificates as either the underlying or
contributing cause of death (Table 1). For example, 85% of the
15,174 mentions of alcoholic cirrhosis as a cause of death in 1980
were recorded as the underlying cause of death; a similar pattern
was
seen with alcoholic gastritis, alcoholic cardiomyopathy, and
alcoholic
psychosis. In contrast, although alcohol dependence was listed as
a
contributing cause of alcohol-related mortality in 13,911 deaths,
it
was only recorded as the underlying cause of death on 4,351 death
certificates, 24% of the total alcohol dependence-associated
deaths.** A similar pattern was seen with the third leading cause
of
alcohol-related mortality, alcohol abuse, which was listed as the
contributory cause in 3,903 (81%) of 4,796 deaths.
Estimates of premature mortality (3) associated with alcohol
misuse among persons aged 1 year through 64 years are based either
on
underlying cause or on contributing cause (Table 2). Alcohol
dependence and alcoholic cirrhosis, the two major reported causes
of
alcohol-related mortality, account for substantial years of
potential
life lost (YPLL) due to alcohol use.** When average YPLL per death
is
examined, however, it is apparent that deaths resulting from the
acute
effects of alcohol account for relatively more mortality in younger
persons. For example, an average of 29.1 years of life were lost
for
each death associated with excessive blood alcohol levels, in
contrast
with 14.4 years lost for each death from alcoholic cirrhosis.
Reported by D Bertolucci, MA, C Lowman, PhD, M Dufour, MD, National
Institute on Alcohol Abuse and Alcoholism, Rockville, Maryland; F
Stinson, PhD, Alcohol Epidemiologic Data System, CSR, Incorporated,
Washington, D.C.; Epidemiologic Studies Br, Div of Surveillance and
Epidemiologic Studies, Epidemiology Program Office, CDC.
Editorial Note
Editorial Note: For two reasons, these data conservatively
estimate
total mortality and premature mortality associated with alcohol
misuse. First, only causes of death presumed to be specific for
alcohol have been included, while other deaths resulting from liver
disease, but not attributed specifically to alcohol misuse (e.g.,
other cirrhosis, ICD-9-CM 571.4-571.9), are excluded. Second,
deaths
from injuries (e.g., motor vehicle incidents, homicides, suicides,
fires, and falls), many of which may be alcohol-related, have been
excluded (4,5). More precise monitoring of the effectiveness of
efforts to reduce morbidity and mortality associated with alcohol
misuse will require more complete reporting on death certificates
or
alternative sources of mortality data.
References
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.
National Center for Health Statistics. The international
classification of diseases, 9th revision, clinical
modification.
Vol. 1. Diseases, tabular list. Ann Arbor, Michigan: Edwards
Brothers, Inc., 1980.
CDC. Table V. Years of potential life lost, deaths, and death
rates, by cause of death, and estimated number of physician
contacts, by principal diagnosis, United States. MMWR
1985;33:27.
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.
CDC. Alcohol and fatal injuries--Fulton County, Georgia, 1982.
MMWR 1983;32:573-6.
*An algorithm is used by NCHS to assign underlying and contributing
causes from those causes listed on the death certificate.
**The two patterns are not mutually exclusive. For a given death
where the underlying cause is alcoholic cirrhosis, for example,
alcohol dependence may be a contributing cause. While underlying
causes can be added across conditions, contributing causes and
total
counts cannot be added.
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