Trends in Alcohol-Related Mortality by Educational Attainment in the US, 2000-2017

Alcohol-related mortality rates in the U.S. have risen since 2000, though how trends vary across socio-economic status is unclear. This analysis combines data from vital statistics and the National Health Interview Survey (NHIS) to estimate alcohol-related mortality rates at four levels of educational attainment (less than high school, high school/GED, some college/associate's degree, 4-year degree, or more) over the period 2000-2017. The analysis includes a comprehensive set of 48 alcohol-related causes of death, including causes which are indirectly influenced by alcohol use. I consider period and cohort patterns in inequality using the relative index of inequality (RII). Results indicate that alcohol-related mortality rates increased over the study period, at all levels of educational attainment. Relative increases were larger for females than males at nearly all ages and levels of educational attainment, and were largest among 45-59-year-old women. Male and female members of the 1950-1959 birth cohort exhibited elevated rates of alcohol-related mortality relative to neighboring cohorts. Despite widespread increases in alcohol-related mortality, educational inequalities present at the beginning of the analysis persisted and exceeded those in all-cause mortality. Disparities were typically greatest among younger adults aged 30-44, though inequality in this age group declined over time. Inequality increased among females aged 60-74, as well as among males aged 45-74. While interventions targeting these groups may reduce educational disparities, care should also be taken to stem the increasing prevalence of alcohol-related deaths at all levels of educational attainment.