Mortality rates for each year of the study period were calculated using SEER*Stat version 8.3.5 (National Cancer Institute), standardized to the 2000 US standard population in 5-year age categories. Rates were calculated separately for men and women for all alcohol-induced deaths, individual causes of alcohol-induced death, and within race/ethnicity categories. The Joinpoint Regression Program version 4.6.0 (National Cancer Institute)14 was used to quantify the overall trends from 2000 to 2016 expressed as average annual percentage changes15 (AAPCs), to detect statistically significant changes in the trajectory of death rates, and to quantify the trends in these segments (expressed as annual percentage changes [APCs]). Statistically significant changes in trend were identified using the Monte Carlo permutation method at a threshold of P < .05.16 We examined potential differences by age in 2 ways. First, age-specific rates, based on 5-year age groups, were calculated for each of 2 periods (ie, 2000-2003 and 2013-2016). These 4-year periods allowed for comparison of age-specific rates between the most recent vs the oldest years within the study period while avoiding instability of data from potentially outlying individual
