Although the current study focuses on the United States, it is important to acknowledge that alcohol is a leading cause of premature mortality worldwide.26 The highest levels of alcohol consumption have consistently occurred in Europe, despite efforts by European Union member states to make alcohol consumption a public health priority, indicating the substantial challenge of alcohol-induced disease.27 Rates of alcohol-induced deaths in the United States have now reached those of the United Kingdom, where the rate of alcohol-specific deaths in 2016 was 11.7 deaths per 100 000 residents.28 However, rates in the United Kingdom have been largely stable since 2013, in contrast with the rapid increases we observed during this period in the United States. In Canada, increases from 2001 to 2017 have also been noted, particularly among women.29 Clearly, alcohol-induced deaths are a major problem worldwide, meriting a substantial public health response.26
