Sobering Statistics: Acceleration of Alcohol-Attributable Deaths Across the United States During the COVID-19 Pandemic

 

Alcohol has long been one of the few legal mind-altering substances in the United States. While legal, messaging around its use – and misuse – has often been mixed. Moderate levels of drinking, such as a glass of wine or beer with dinner, were once recommended as a way to promote better heart health and to help control blood sugar and cholesterol levels.^1,2  

Lately, however, the public health sphere has become awakened to the fact that even a small amount of alcohol can lead to negative health consequences, increasing risks for a number of chronic diseases and different types of cancer.³ These risks are even more pronounced for women who, biologically, process alcohol differently than men, and face higher odds of developing chronic health conditions, disease, and even increased risk of death from alcohol-induced causes.^4,5

Using vital statistics data from the CDC’s WONDER system, a new brief from SHADAC researchers examines the concerning rise in alcohol-attributable deaths among women, which underscore larger patterns of growth seen across the U.S. We also examine differences in alcohol-attributable deaths between demographic groups, including by age, race and ethnicity, and geographic location during the COVID-19 pandemic period (2019-2022).

Key findings from our analysis of alcohol-attributable deaths during this time include:

• While men have traditionally seen high rates of alcohol-attributable deaths, women saw a 33% increase in alcohol-attributable deaths from 2019 to 2022 – an acceleration over the 28% growth in the rates of their male counterparts.

• Alcohol-attributable death rates for American Indian and Alaska native people, already at historic highs, surged by over 20 percentage points (from 54.0 deaths per 100,000 people in 2019 to 78.4 per 100,000 people in 2022) – well over the rate for the overall U.S. population (13.5 deaths per 100,000 people).

• Rates also increased for people living in non-metro (i.e., rural) areas during the pandemic, rising by 36% from 14.5 per 100,000 people in 2019 to 19.6 per 100,000 people in 2022.

Each of these individual trends make up an alarming larger pattern of accelerating alcohol-attributable death rates reaching all the way back to 2006, the year that the data for alcohol-attributable deaths first revealed any increase. While rates for years prior to 2006 remained generally stable, rates began steadily rising from 2006 onward, growing by nearly 30% from 7.4 alcohol-attributable deaths per 100,000 people to 10.4 per 100,000 people just prior to the COVID-19 pandemic in 2019. During the pandemic, this rate grew again by 30% from 10.4 deaths per 100,000 people to 13.5 death per 100,000 in 2022 in just three years – a worrying acceleration.

To learn more about alcohol-related deaths and our analysis of these trends, read the full brief, "Sobering Statistics: Acceleration of Alcohol-Attributable Deaths Across the United States During the COVID-19 Pandemic".

SHADAC has also built an interactive map that shows rates of alcohol-attributable deaths for the U.S. and the states from 2006 to 2022 for you to explore the data yourself. Start exploring below.

---

Notes and Citations

1. Callahan, A. (2024, February 17). How Red Wine Lost Its Health Halo. The New York Times. https://www.nytimes.com/2024/02/17/well/eat/red-wine-heart-health.html

2. Richardson, C. (2023, February 10). Is beer healthy? How much should people drink? Medical News Today.  https://www.medicalnewstoday.com/articles/is-beer-healthy

3. National Cancer Institute. (2021, July 14). Alcohol and Cancer Risk. National Institutes of Health. https://www.cancer.gov/about-cancer/causes-prevention/risk/alcohol/alcohol-fact-sheet

4. Centers for Disease Control and Prevention (2024, September 19). Sex and Gender Considerations on Alcohol Use and Health. https://www.cdc.gov/alcohol/about-alcohol-use/alcohol-and-gender-considerations.html

5. Zhao, J., Stockwell, T., Naimi, T., Churchill, S., Clay, J., & Sherk, A. (2023, March 31). Association Between Daily Alcohol Intake and Risk of All-Cause Mortality: A Systematic Review and Meta-analyses. JAMA Network Open, 6(3), e236185. doi:10.1001/jamanetworkopen.2023.6185

New Brief from SHADAC and UMN Cannabis Research Center: Using the Minnesota Student Survey to understand cannabis use and perceptions among high school students

As of 2023, Minnesota legalized cannabis for non-medical use by adults, becoming one of the now 24 states with such policies. Minnesota’s cannabis legislation limits legal cannabis use to adults aged 21 and older, similar to other states’ legislation for cannabis, tobacco, and alcohol use as well. 

Despite the legislation prescribing this age restriction, many policymakers and other stakeholders are concerned with the impact legalized cannabis could have on public health in general and on youth populations, specifically. 

“As cannabis policy continues to develop in Minnesota, and once legal sales of cannabis begin, it will be crucial to study youth cannabis use and to use those findings to fine-tune the state’s approach to minimize public health risks for youth,” says SHADAC and Cannabis Research Center (CRC) researcher Colin Planalp.

Commercial sales of legal cannabis in Minnesota have not yet begun, and they are not expected until 2025. However, the Cannabis Research Center (CRC) and SHADAC — both centers housed at the University of Minnesota’s School of Public Health — have already begun work to understand potential effects this legislation could have on youth. In fact, researchers purposefully wanted to start research and use data from before the beginning of commercial sales in order to provide key baseline evidence on cannabis use and perceptions among youth.

Thus, in their newest brief, researchers from the CRC and SHADAC used data from the Minnesota Student Survey (MSS) to study youth experiences with and perceptions of cannabis and other substances prior to legalization. This brief specifically looks at:

• Self-reported cannabis use
• Differences between demographic groups’ cannabis use
• Perceived prevalence of cannabis use by peers

You can read the brief in full here or by clicking the image to the right.

Interested in Minnesota cannabis policy? Want to learn more about the potential public health implications of cannabis use and legalization? Check out some of SHADAC and the CRC’s other collaborative pieces:

• Accompanying Blog: Using the Minnesota Student Survey to understand cannabis use and perceptions among high school students
• Brief: Public Health Implications of Cannabis Policy in Minnesota
• Brief: Perceptions and Opinions Relating to Cannabis in Minnesota

Planalp, Colin
Research Fellow

p 612-624-4850
e cplanalp@umn.edu

Understanding cannabis use and perceptions among Minnesota high school students

Most 9th and 11th graders report never having tried cannabis, but rates of recent use vary by demographic groups

In 2023, Minnesota became one of a growing number of states that have legalized cannabis for non-medical use by adults. When lawmakers crafted Minnesota’s legislation, they established a minimum age of 21 to use and purchase cannabis, similar to policies in other states that have legalized, and consistent with alcohol and tobacco policies. 

The decision to limit legal access to cannabis to adults age 21 and older reflects common concerns about the potential for cannabis use to harm youth. While research on the public health implications of cannabis use is limited, studies have found associations between adolescent use of cannabis and a variety of negative outcomes, including lower educational attainment and worse school performance, as well as mental health and substance use disorders.^1,2,3,4

Other states that legalized cannabis earlier and have had time to examine impacts of that legislation have generally not found clear increases in underage use since policies changed and legal sales began.^5,6 Nevertheless, it will be important to monitor this issue in Minnesota, as experiences with alcohol and tobacco demonstrate that policies and enforcement matter when limiting substance use by youth. 

Though commercial sales of legal cannabis in Minnesota aren’t expected to begin until 2025, researchers at the University of Minnesota School of Public Health’s Cannabis Research Center and SHADAC sought to get a head-start in understanding potential effects on youth. To do this, researchers began by studying youth experiences with and perceptions of cannabis and other substances prior to legalization. Our aim is to provide researchers, policymakers, and community members with key baseline evidence that can illuminate the current cannabis landscape, so it may be compared to post-legalization data in the coming years.

Cannabis and Other Substance Use Has Been Declining Among Youth in Minnesota

Using data from the Minnesota Department of Education’s Minnesota Student Survey, we produced estimates of the experiences and perceptions of Minnesota 9th and 11th graders (i.e., high school students) pertaining to cannabis, alcohol and tobacco, as well as some measures on nicotine-vaping products — a newer phenomenon for which less data is available. 

Among the most important findings include:

• Almost 9 in 10 (86%) Minnesota high school students said in 2022 that they had never used cannabis, and the rate of students saying they had never used cannabis has been increasing over time.

• Less than 1 in 10 (8%) Minnesota high school students reported having used cannabis in the past month, but that percentage varied across demographic groups. For instance, only 3% of Asian students reported using cannabis in the past month, but 17% of American Indian and Alaska Native students reported they had used cannabis in the past month.

• Minnesota high school students appear to overestimate the prevalence of cannabis use by their peers. While half (50%) said they believed most of their peers use cannabis monthly, only 7% reported that they themselves use cannabis monthly — a similar pattern of apparent overestimation of substance use by peers as for alcohol and tobacco use.

More Research on Youth Use Necessary Once Legal Cannabis Sales Begin

The findings of our study are somewhat reassuring: despite the stereotype of teenagers experimenting with substances, most Minnesota high school students report they aren’t using cannabis — or alcohol, tobacco, and nicotine-vaping products. 

However, even with 8% of Minnesota high school students reporting cannabis use, that represents tens of thousands of youth in the state. That is concerning, based on research that suggests various risks related to underage cannabis use.

Research from other states suggesting that legalization doesn’t necessarily lead to an unavoidable increase in underage cannabis use is reassuring, but we shouldn’t take that for granted. As cannabis policy continues to develop in Minnesota, and once legal sales of cannabis begin, it will be crucial to study youth cannabis use and to use those findings to fine-tune the state’s approach to minimize public health risks for youth.

Click here to read the full brief on this subject.

[1] National Academies of Sciences, Engineering, and Medicine. (2017). The Health Effects of Cannabis and Cannabinoids: The Current State of Evidence and Recommendations for Research. The National Academies Press. https://doi.org/10.17226/24625.

[2] Volkow, ND, Swanson, JM, Evins, AE, et al. (2016). Effects of Cannabis Use on Human Behavior, Including Cognition, Motivation, and Psychosis: A Review. JAMA Psychiatry. 73(3), 292-297. doi:10.1001/jamapsychiatry.2015.3278

[3] Winters, KC, Lee, CY. (2008). Likelihood of developing an alcohol and cannabis use disorder during youth: association with recent use and age. Drug and Alcohol Dependence. 92(1-3), 239-247. https://doi.org/10.1016%2Fj.drugalcdep.2007.08.005

[4] Tervo-Clemmens, B, Gilman, J, Evins, E. (2024). Substance Use, Suicidal Thoughts, and Psychiatric Comorbidities Among High School Students. JAMA Pediatrics. 178(3), 310-313. doi:10.1001/jamapediatrics.2023.6263

[5] Esie P, Ta M. (2024). Cannabis Use Among Students in Grades 8, 10, and 12, by Sex — King County, Washington, 2008–2021. MMWR Morbidity and Mortality Weekly Report. 73:27–31. https://www.cdc.gov/mmwr/volumes/73/wr/mm7302a1.htm

[6] Colorado Department of Public Health and Environment. (2022). CDPHE releases latest Healthy Kids Colorado Survey data. https://cdphe.colorado.gov/press-release/cdphe-releases-latest-healthy-kids-colorado-survey-data-0

Tatiana "Annie" Gowlovech
Research Assistant

Cancer Screening Data: Adults Who Have Received Recommended Cancer Screenings by Coverage Type, Education Level, and Race/Ethnicity in 2022

Cancer screening for adults plays a pivotal role in early detection, increasing the chances of successful treatment and preventing thousands of cancer deaths. Despite their life-saving potential, many adults may choose to delay or skip these screenings due to various barriers, such as limited access, transportation issues, fear of diagnosis, or poor understanding of the importance. To effectively address the root causes of underutilization, it's crucial to first understand the landscape of cancer screening rates for varied populations and communities.

State Health Compare offers a comprehensive view of state-level data on adults receiving recommended cancer screenings, for the civilian noninstitutionalized population. This valuable resource provides insights into screening rates across different coverage types, education levels, and racial/ethnic groups. Screenings in this data include:

• Pap smears (cervical cancer screening)
• Colorectal cancer screenings
• Mammograms (breast cancer screening)

In this blog post, SHADAC researchers delve into the breakdowns between the different groups to understand disparities and/or differences of cancer screening rates for various populations. For this analysis, we used data from the 2022 Behavioral Risk Factor Surveillance System (BRFSS) on State Health Compare.

Methods

To begin, we first needed to understand the total number of adults who received recommended cancer screenings. We found that, in 2022, 62.6% of US adults received recommended cancer screenings.

We then conducted statistical testing of rates within each of the previously mentioned demographic categories to see if they were significantly higher or lower than the national rate.

Breakdown by Coverage Type

This breakdown examined cancer screening rates for adults by multiple types of insurance coverage.

Some coverage groups had significantly lower cancer screening rates compared to the national rate. Uninsured adults had the lowest rate of cancer screenings in 2022, with 34.0% receiving recommended cancer screenings. Adults that were insured through Medicaid in 2022 also had a significantly lower rate of receiving annual cancer screenings, with a percentage of 57.7%.

Explanations of why these differences occur vary. One possible explanation is the cost of screenings. Those who are uninsured would be required to pay for cancer screenings out of pocket, which can be expensive and cost prohibitive, leading to people forgoing these services. Additionally, many people and families covered under Medicaid are low-income. Even with insurance coverage, individuals may not be able to pay for preventative screenings, have transportation to appointments, be able to take off work or find childcare, etc.

On the other hand, some coverage groups had significantly higher rates of cancer screenings compared to the national rate. Adults with public insurance and Medicare both had significantly higher rates of receiving cancer screenings, with rates of 66.4% and 70.7%, respectively. 

Again, possible explanations for this vary. One explanation is that under the Affordable Care Act, Medicare must cover cancer screenings. This guaranteed coverage could explain the higher rate of individuals with Medicare receiving their recommended screenings.  

Of those with individual insurance, 59.0% reported receiving recommended screening, which was not statistically different from the US rate. Adults with private and employer/military insurance also did not have a significant rate of annual cancer screenings compared to the US rate, with 62.5% and 63.2%, respectively, reporting receiving annual cancer screenings.

Breakdown by Education Level

Multiple levels of cancer screening data by educational attainment were examined displayed in the graph below.

Two of these groups had significantly lower rates of adults receiving recommended cancer screenings. First was US adults with less than a high school degree, with 47.2% receiving recommended cancer screenings in 2022 (significantly lower than the US rate). The rate for adults who are high school graduates (without further higher education) is also significantly lower than the US rate at 58.8%.

There is no significant difference between the US rate (62.6%) and the rate for adults with some college or an Associate’s degree (63.0%).

Finally, 68.0% of US adults with a Bachelor’s degree or higher reported receiving recommended screenings, which is significantly higher than the US rate. A possible explanation for this higher rate is that individuals with higher educational attainment may be more knowledgeable regarding the importance of receiving preventative care, as well as having the means to seek preventative care.

As individuals with lower educational attainment have lower rates of cancer screening, they also have higher prevalence of modifiable cancer risk factors. Modifiable risk factors for cancer include smoking, excess body weight, alcohol intake, physical inactivity, and poor diet. There are notable educational disparities in cancer prevention in terms of incidence, treatment, and mortality. This reveals the importance of tailoring screening programs and providing educational material to individuals with lower education levels.

Breakdown by Race/Ethnicity

Finally, we were able to create a breakdown of cancer screening rates by racial/ethnic groups.

Note: these groups were selected based on available data. State Health Compare does not have available data for some race/ethnic groups, due to low response rates. However, SHADAC is hopeful this data gap will be addressed in the future in order to conduct equitable analyses.

Compared to the US rate, Hispanic/Latino adults and adults of other/multiple races had significantly lower rates of receiving recommended cancer screenings in 2022, with respective rates of 55.6% and 56.9%.

Approximately two-thirds of both African American/Black adults (64.6%) and White adults (64.9%) reported receiving recommended cancer screenings—both of which are significantly higher than the US rate.

Our analysis shows that there are differences in cancer screening rates between racial/ethnic groups—with our analysis seeing Hispanic and other/multiple race individuals with the lowest screening rates in the US. Other research supports and, in fact, shows even greater inequities than this. Racial disparities not only impact screening rates, but also cancer diagnosis and treatment. Persons of color may receive later stage cancer diagnoses compared to their White counterparts, due to disparities in screening quality and delays in diagnostic evaluations.

Also, persons of color may not be seeking out cancer screening services due to distrust in the healthcare system, discrimination, bias, or unpleasant past experiences.

Final Thoughts

Examining recommended annual cancer screening rates by coverage type, education level, and racial/ethnic group reveals that although the national rate may seem relatively high, there are still groups that face disparities in accessing and utilizing such a vital tool for improving cancer treatment and preventing death.

While this blog has looked at singular category breakdowns, it is important to note the intersectionality between insurance coverage, education level, race/ethnicity, and many other factors. For example, individuals without a high school diploma have the highest uninsurance rates. Race/ethnicity also appears to be correlated with rates of uninsurance. When looking at race and uninsured rates, there are higher uninsurance rates for American Indian or Alaska Native (AIAN), Hispanic, Black, and Native Hawaiian or Pacific Islander (NHPI) individuals compared to their White counterparts.

Therefore, of the groups that have significantly lower rates of cancer screenings compared to the US rate, many individuals may fall into multiple of these sub-categories. Further research and analysis could shed light on how these many factors interact and lead to different (and varied) results and outcomes.

By understanding these disparities, not only can we draw attention to improving public health education and literacy for these populations, but also find meaningful ways to identify and address barriers (individual and structural) that may be hindering these same individuals from accessing the preventative care they need.

Interested in learning more about disparities and health equity in the United States? You can explore the data yourself using the State Health Compare Tool here.

You can also read some of our other products highlighting State Health Compare data, like:

• Unemployment Rate Trends of the Past 5 Years: Pre-, Mid-, and Post-Pandemic
• Revised Childhood Vaccinations Measure on State Health Compare Shows Vaccination Rates Vary by State, Race/Ethnicity, and Insurance Coverage

Perceptions and Opinions Relating to Cannabis in Minnesota

Using data from the National Survey on Drug Use and Health (NSDUH), this brief explores people’s perceptions and opinions related to cannabis and cannabis use prior to its 2023 legalization in Minnesota. The brief begins with an overview of the context of cannabis policy and use in the United States before moving into analysis of perceptions on cannabis prior to legalization. Specifically, researchers analyzed respondents’ opinions on:

• How easy or hard it would be to obtain cannabis
• Perceived risk associated with smoking cannabis
• Disapproval (or lack thereof) of cannabis use by adults (age 18+) and youth (age 12-17)

Researchers from the University of Minnesota School of Public Health’s State Health Access Data Assistance Center (SHADAC) and Cannabis Research Center (CRC) present data on these three topics for Minnesota specifically and for the U.S. as a whole.

Examining data prior to legalization helps both researchers and the public understand Minnesota’s perceptions and attitudes surrounding cannabis before policy changes – then, as we move forward, we can compare this to post-policy data to understand what has changed, what hasn’t changed, and, hopefully, begin to answer common questions regarding cannabis use and legalization.

Will cannabis use increase with legalization? Will increased consumption lead to greater public health harms? Will rates of use increase for youth? Will perceived risk of use decrease with legalization?

“The answer [to these questions] may depend, in part, on whether the changing legal status of cannabis also changes social norms and people’s perceptions about cannabis, such as reducing social stigma associated with cannabis use,” says SHADAC and CRC Researcher Colin Planalp.

The data in this brief are intended to provide information to Minnesota policymakers as they set up the state’s regulatory framework surrounding cannabis. It also aims to give Minnesotans helpful information as they navigate the new choices that come with the lifting of decades of cannabis prohibition.

Continued research and monitoring of these and other issues will be crucial as cannabis policy, attitudes, and social norms evolve. Examining and understanding these opinions and perceptions can potentially reveal hints at how the cannabis landscape may change as a result of legalization.

Read the brief in full here. Additionally, SHADAC and the CRC authored a companion brief using the same survey data to examine the potential public health implications of cannabis policy in Minnesota. You can find that brief here.

Interested in learning more about cannabis policy in Minnesota, substance use, and related topics? Check out the following resources:

• SHADAC blog accompanying this brief - “Measuring Perceptions and Opinions on Cannabis Use in Minnesota” 
• Brief on the United States Opioid Crisis – “Opioid Crisis in the Pandemic Era”
• Cannabis Research Center Website
• Explore data on the topic of substance use, alcohol-involved deaths, and more on State Health Compare