Our results for mortality are generally supported by prior studies identifying increases in alcohol use, high-risk drinking, and alcohol use disorders over recent years, particularly among women and other population subgroups not traditionally recognized as being at high risk.6,18,19,20,21 While we noted widespread increases geographically, our observation that the highest rates of death among white individuals occurred in the western United States echoes prior observations that states within this region had some of the highest historical per capita alcohol consumption levels.21 However, alcohol consumption levels are unlikely to fully explain mortality trends. Lack of access to high quality care for alcohol misuse and alcohol-associated diseases plays an important role in mortality vs morbidity.21 Indeed, alcohol-induced deaths should be considered a function of both alcohol misuse and insufficient primary, secondary, and tertiary prevention.
