Epidemiology of Alcohol Use and Alcohol-Related Problems

Part 1. Incidence Rates

Epidemiology, the study of the population rate and distribution of problematic events or conditions, originally developed as a branch of public health and focused primarily on rates of infectious disease. However, contemporary social scientists use epidemiological methods to examine an extensive range of norm-violating phenomena in various populations, including rates of violence, psychiatric disorder, and drug use. In describing rates of disease or other problematic conditions in a given population, epidemiologists distinguish between two types of rate: incidence and prevalence.

In general, incidence refers to the rate of new cases of a condition (or an event) during a given period of time. The most important examples of incidence data in the study of alcohol and drug problems are rates of mortality—death rates—due to drug-related causes, such as overdose deaths, DUI fatalities, alcohol poisoning or liver cirrhosis.  Recent increases in the incidence of alcohol- and drug-related mortality among middle-aged, non-Hispanic whites in the U.S. have received widespread attention in the news media and the public health community.  Anne Case and Angus Deaton (2015; 2017) examined annual rates of morbidity (poor health) and mortality due to various causes for the adult populations of the U.S. and other nations from 1999 to 2015.  As shown in Figure 1 of their 2015 report (below left), one of their most striking findings is a significant upward trend in overall (“all-cause”) mortality rates for non-Hispanic white adults aged 45-54 during the initial years of the 21st century.  This recent rise in death rates represents a marked reversal of the long-term improvement in population mortality for all age groups throughout the 20th century in the U.S.  It also stands in sharp contrast to the continuing downward trend in mortality rates for middle-aged adults in all other Western nations as well as for Hispanic adults and black non-Hispanic adults in the U.S.  What accounts for this unique increase in mortality rates among these white “baby-boomers”?

To answer this question, Case and Deaton examined trends in the incidence of specific causes of death among middle-aged whites.   Their findings, shown in Figure 2 (below right), paint a disturbing picture of a generation in distress.  Steep increases in mortality from 1999 to 2013 due to drug- and alcohol-poisoning (overdose), suicide, and chronic liver disease reveal the terrible toll of “deaths of despair” among middle-aged white Americans.  Additional analyses indicated that increases in drug-related deaths and suicide were especially dramatic among whites with no more than a high-school education, whose employment prospects and quality of family life have steadily deteriorated in recent decades.  In their 2017 paper, Case and Deaton (p. 34) conclude that “cumulative distress, and the failure of life to turn out as expected is consistent with people [resorting to suicide or] compensating through other risky behaviors such as abuse of alcohol, overeating or drug use that predispose” them to fatal outcomes.  In many respects, Case and Deaton’s analysis and interpretation of these incidence data echo Robert Merton’s (1938; 1957) classic conception of “retreatism” as a deviant adaptation to structural strain and anomie in U.S. society.  Failure of the American Dream is as painful in the 21st century as it was during the Great Depression of the 1930s—and many thousands of people are dying as a result.

DAWN emergency department episodes
DAWN emergency department episodes

Figure 1. All-cause mortality, ages 45-54 for US white non-Hispanics (USW), US Hispanics (USH), and six comparison countries: France (FRA), Germany (GER), the United Kingdom (UK), Canada (CAN), Australia (AUS), and Sweden (SWE).

Figure 2. Mortality by cause, white non-Hispanics ages 45-54.

 


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