Overview

• Fatalities peaked in 2021 at 54,258, and by 2024 the average county death rate remained about 25% higher than in 2019 despite some decline from the peak.
• Women aged 25–34 experienced the largest increase since 1999 (up 255% to 3.2 deaths per 100,000), followed by men 25–34 (up 188% to 6.5).
• American Indian/Alaska Native communities faced the highest per-capita mortality, with male rates triple and female rates quadruple those of white Americans across the study period.
• Most deaths were attributed to alcoholic liver disease, with alcohol-related mental and behavioral disorders contributing to a lesser extent.
• The observational analysis used CDC vital statistics for 14 alcohol-induced causes and excluded many chronic conditions linked to alcohol, likely understating the overall toll and reinforcing calls for targeted policies and expanded treatment access.