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A new study adds to a mounting body of evidence showing that rising alcohol consumption among women is leading to higher rates of death and disease. The report, published Friday in the journal JAMA Health Forum, examined insurance claims data from 2017 to 2021 on more than 14 million Americans ages 15 and older. Researchers found that during the first year and a half of the coronavirus pandemic, women ages 40 to 64 were significantly more likely than expected to experience serious complications like alcohol-related cardiovascular and liver disease, as well as severe withdrawal.
The Background
Alcohol consumption in the United States has generally increased over the last 20 years, said Dr. Timothy Naimi, the director of the Canadian Institute for Substance Use Research at the University of Victoria. Dr. Naimi was a co-author on a recent paper that showed deaths from excessive alcohol use in the United States rose by nearly 30 percent between 2016 and 2021.
While men still die more often from drinking-related causes than women, deaths among women are climbing at a faster rate. “The gap is narrowing,” said Dr. Bryant Shuey, an assistant professor of medicine at the University of Pittsburgh and the lead author of the new study.
The Research
The study looked at serious health issues related to drinking, including alcohol-related liver and heart disease, inflammation of the stomach lining that led to bleeding, pancreatitis, alcohol-related mood disorders and withdrawal. Researchers compared insurance claims data for these complications with the rates they expected to see based on past prevalence of these conditions.
In nearly every month from April 2020 to September 2021, women ages 40 to 64 experienced complications from alcohol-related liver disease — a range of conditions that can develop when fat begins to accumulate in the liver — at higher rates than researchers predicted. If damage from drinking continues, scar tissue builds up in the liver and leads to a later stage of the disease, called cirrhosis. Some people with alcohol-related liver disease also develop severe liver inflammation, known as alcohol-associated hepatitis.
Rates of alcohol-related complications during the pandemic were also higher than predicted among men ages 40 to 64, but those increases were not statistically significant. But “men are not out of the woods” and still face health risks, Dr. Shuey said.
The Limitations
The study examined data only up until September 2021. Katherine Keyes, a professor of epidemiology at Columbia University who was not involved in the latest study, said she expected that alcohol use might keep rising among women — a pattern that could contribute to even more health issues.
And since the study relied on insurance claims, Dr. Shuey said it told an incomplete story. If someone is treated in the emergency room for an inflamed pancreas but doesn’t disclose a drinking history, for example, that instance may not be registered as an alcohol-related complication.
“The truth is, we’re probably underestimating this,” he said.
The Takeaways
These findings underscore how patterns of heavy drinking can translate into serious health consequences. Over the last 10 years, a growing number of American women — and particularly women in middle age — have reported binge-drinking, Dr. Keyes said.
“It used to be that 18- to 25-year-old males were the most likely to drink or the most likely to binge,” said Aaron White, a neuroscientist at the National Institute on Alcohol Abuse and Alcoholism. Now, binge drinking occurs more among people between the ages of 26 to 34, and is becoming more common among women. “Everything’s just getting pushed back later,” he said.
Demographic shifts can also help explain why women are drinking at higher rates, Dr. Keyes said. Women tend to marry and have children at later ages than in previous decades, so they spend more time in what Dr. Keyes calls a “high-risk period for heavy drinking.”
“People don’t realize the real health consequences these heavy drinking patterns can have,” she added.
These consequences take time to develop and often emerge between ages 40 and 60. Complications can occur after “years of heavy, persistent alcohol use,” Dr. Shuey said.
These longer-term increases in drinking predate the pandemic and might have increased the risk of health problems among women before Covid-19 hit. But higher levels of drinking during lockdowns may have exacerbated these issues or contributed to new complications, especially as women bore the brunt of family responsibilities, Dr. White said.
Even as research mounts on the harms of alcohol, many people might struggle to change their habits, Dr. White said.
“If you’ve been drinking wine with dinner every night for the last 20 years, just seeing a headline is not going to be enough to make you throw your wine away,” he said. “I think it’s going to be a slow cultural shift.”
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