Alcohol-induced deaths rose nearly 25% in Wisconsin in 2020, the biggest one-year increase in more than two decades. This was just slightly below the national increase during the early months of the COVID-19 pandemic, but Wisconsin started with a higher rate of such deaths than the national average, and last year’s increase exacerbated a trend that warrants consideration of underlying causes and appropriate policy responses.
Newly released mortality data from the U.S. Centers for Disease Control and Prevention (CDC) show an alarming upward trajectory of deaths directly linked to excessive alcohol use nationally. This is also the case in Wisconsin, but to a greater extent.
These data, drawn from death certificates of U.S. residents, show 1,077 Wisconsinites died in 2020 due to alcohol-induced causes, up from 865 in 2019. The 24.5% rise – which includes only the deaths that were most directly attributable to alcohol use but excludes others where alcohol may have been a factor – was the largest year-over-year increase within the data going back to 1999. Monthly data show the large spike in deaths began in July 2020 (see Figure 1).
The increase in Wisconsin was slightly less than a 25.7% increase nationally between 2019 and 2020, as more than 49,000 Americans lost their lives last year to alcohol-induced causes. These findings fit with a broader picture of previous Forum research and other findings that alcohol use rose considerably amid the stress and isolation of the pandemic. They also raise the possibility of additional and potentially more extensive health and economic impacts from drinking that fall short of death but are still significant.
Rather than a onetime occurrence related to the pandemic, the findings for 2020 highlight a longtime trend: nationally, the number of deaths due to alcohol has steadily increased. That trend is even more pronounced in Wisconsin, a state where rates of binge drinking exceed those seen nationally. From 1999 (the first year for which CDC data are available) through 2020, Wisconsin’s rate of alcohol-induced deaths per 100,000 residents nearly tripled, increasing from 6.7 to 18.5. That compared to a national increase in this period of 113.4%, from 7.0 to 14.9. Overall, Wisconsin residents died from alcohol-induced causes at a rate nearly 25% higher than the nationwide rate in 2020.
Notably, deaths from drug-induced causes are also happening in Wisconsin at a higher rate (26.7 per 100,000 in 2020) and have increased faster (up more than six-fold since 1999) than alcohol-induced deaths. However, we focus here on alcohol-induced deaths in light of our other recent research on increased alcohol use and related impacts and our perception that more attention has been given to drug-induced deaths in recent years compared to those from drinking.
Middle-aged Wisconsinites See Biggest Impact
U.S. death certificates provide a single underlying cause of death for the deceased person, additional multiple causes as warranted, and demographic data. These data from the National Vital Statistics System provide insight into trends in mortality by cause of death as well as by geography, race, age, and other factors.
The deaths examined in this report are a category defined by the CDC as “alcohol-induced deaths.” It is crucial to note this category excludes many deaths to which alcohol use may have contributed, such as motor vehicle accidents, falls, cancers, suicide, or violence. Rather, this definition includes deaths directly attributable to excessive drinking such as alcohol poisoning and certain liver, neurological, digestive system, or other diseases. In fact, around 90% of alcohol-induced deaths are from alcoholic liver disease or mental/behavioral disorders caused by the use of alcohol.
We focus in this report on data available through 2020. Our analysis shows alcohol-induced deaths have risen over time among virtually every demographic cohort in Wisconsin, by age, race, gender, and geography. Yet, middle-aged Wisconsinites have experienced the most pronounced impacts.
As shown in Figure 2, the alcohol-induced death rate per 100,000 people among Wisconsinites ages 45-64 increased 158.9% from 1999 to 2020 (15.9 per 100,000 to 41.3), compared to a 112.9% increase among Wisconsinites ages 25-44 (4.5 to 9.6), and a 106.1% increase among those ages 65 to 84 (15.5 to 31.9).
Higher death rates among middle-aged and older individuals likely reflect the fact that many alcohol-induced deaths, such as liver disease, typically occur after many years of heavy drinking. Alcohol deaths more frequently associated with younger people, such as alcohol poisoning, comprise a very small share of the total, though they have increased as well.
Notably, the mortality increases by age in Wisconsin differ from the nation, which saw deaths rise more during this period among younger Americans relative to older ones. Nationally, the increase among Americans ages 25-44 from 1999 to 2020 was 105.2% (5.2 per 100,000 to 10.8), compared to 93.9% among Americans ages 45-64 (17.3 to 33.5), and 65.9% among those ages 65 to 84 (13.8 to 22.8).
Concerning trend among Black Wisconsinites
Our analysis also finds long-term increases in deaths from alcohol use among all racial and ethnic groups. In Wisconsin and nationally, American Indian and Alaskan Natives have had a much higher rate of alcohol-induced deaths than those who identify as Black, white, and Hispanic.
In the state, 66.0 American Indian or Alaska Natives per 100,000 died in 2020 from alcohol-induced causes, compared to a rate of 15.6 for Black Wisconsinites, 19.7 for white Wisconsinites, and 9.2 for Hispanic Wisconsinites. Increases over time for both white and American Indian and Alaska Native state residents have closely tracked national rates, while alcohol-induced death rates among Hispanic Wisconsin residents have begun to rise only over the last few years.
One point of concern is the sharp rise in the rate of alcohol-induced deaths for Black Wisconsinites over the last decade, when it began to diverge from the rate for all Black Americans. Nationally, the alcohol-induced death rate for Black Americans has been below that of white Americans since 2002, and in 2020, significantly more white Americans per 100,000 were dying (17.6) each year compared to Black Americans (10.0).
In Wisconsin, alcohol-induced death rates for Black Wisconsinites largely tracked those for all Black Americans until 2012, when they rose sharply. In 2019, the alcohol-induced death rate for Black Wisconsinites (17.0) was higher than the rate for white Wisconsinites (15.1) for the first time since 2005 (see Figure 3). In 2020, the death rate for Black Wisconsinites declined slightly, but still remains far above the national death rate for all Black Americans: only Colorado (24.8), New Mexico (24.6), and Nebraska (20.9) had higher alcohol-induced death rates for Black residents than Wisconsin (15.6).
Policy Considerations and Conclusion
In recent years, attention paid to mortality trends often has centered on the rising toll of opioid deaths and most recently, on the pandemic that has now claimed more than 800,000 American lives. Yet in the meantime, deaths caused by alcohol have quietly accelerated.
As we have noted, challenges from excessive drinking appear particularly acute in Wisconsin. From 2000 to 2010, alcohol-induced deaths in the state increased by 26.6%; from 2010 to 2020 they more than doubled, increasing by 115.4%. Nearly two-thirds of the 2010-to-2020 increase occurred before the pandemic.
Several factors may help to explain the divergence between Wisconsin and the rest of the nation when it comes to consumption. Research from the National Institute on Alcohol Abuse and Alcoholism shows that from 1980 to 2009, Wisconsin’s rate of ethanol consumption placed it among the top 10 states each year on a per capita basis.
A 2019 report from the University of Wisconsin Population Health Institute found that rates of binge drinking across all age and gender groups were higher in Wisconsin than nationwide; meanwhile, CDC data shows that in 2015, Wisconsin had the second-highest prevalence of binge-drinking of any state. The CDC defines binge drinking as consuming enough to bring a person’s blood alcohol concentration (BAC) to 0.08 g/dl or more, which for women would be about 4 or more drinks in about 2 hours, and for men would be about 5 or more drinks in about 2 hours.
These factors and high consumption going back decades could help explain why alcohol-induced death rates among Wisconsin’s middle-aged and older populations have risen so much. Still, more research is needed into Wisconsin-specific trends, including the alarming rise in alcohol-related death rates among Black Wisconsinites.
With regard to potential policy responses, research has found that higher tax rates or prices on alcohol can reduce consumption. While it would likely be politically unpopular, this suggests that Wisconsin policymakers may want to consider whether current alcohol taxation rates should be revisited; Wisconsin currently taxes alcohol at some of the lowest rates nationwide.
A 2020 brief from the U.S. Department of Health and Human Services (HHS) also suggests taking steps to make alcohol less readily available, such as curbing the issuance of liquor licenses or reducing the amount of hours in a day during which alcohol can be sold. Wisconsin has more than 1,800 municipal licensing bodies, each of which may interpret how much is too much alcohol in a community differently.
Notably, such an approach would run contrary to some measures adopted in Wisconsin, which recently expanded access to alcohol in the state by allowing bars and restaurants to sell “to-go” cocktails to help these businesses during the pandemic.
We acknowledge the political difficulty involved with any attempt to curb alcohol use by making the product more expensive or reducing its availability and accessibility. Increased taxes on alcohol also might have a disproportionate impact on certain low-income populations.
Yet, if these responses are deemed untenable or undesirable, then the trends highlighted in this report suggest that policymakers also should consider putting more resources into prevention, intervention and treatment for alcohol abuse. With the state’s budget surplus at a historic high, the state is better-positioned to do so from a financial perspective than it has been in quite some time and preventing abuse could also reduce long-term taxpayer-funded costs in areas like health care and law enforcement.
Ultimately, our findings that alcohol-induced death rates in Wisconsin are both higher than the national average and on an alarming upward trajectory should not be ignored. With this longstanding problem growing progressively worse, policymakers may wish to prioritize debate about a comprehensive range of potential responses in 2022.