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Excessive alcohol consumption causes more than 100,000 deaths annually in the United States, and although the number shows little sign of declining, the rate per 100,000 population has trended down since the early 1980s. Accidents, mostly due to drunken driving, accounted for 24 percent of these deaths in 1992. Alcohol-related homicide and suicide accounted for 11 and 8 percent respectively. Certain types of cancer that are partly attributable to alcohol, such as those of the esophagus, larynx, and oral cavity, contributed another 17 percent. About 9 percent is due to alcohol-related stroke. One of the most important contributors to alcohol-related deaths is a group of 12 ailments wholly caused by alcohol, among which alcoholic cirrhosis of the liver and alcohol dependence syndrome are the most important. These 12 ailments together accounted for 18 percent of the total alcohol-related deaths in 1992. Mortality due to the 12 causes rises steeply into late middle age range and then declines markedly, with those 85 and over being at less than one-sixth the risk of 55 to 64-year olds.
The most reliable data are for the 12 conditions wholly attributable to alcohol. The map shows these data for all people 35 and over. The geographical distribution for men and women follows much the same pattern, although men are three times as likely to die of one of the 12 alcohol-induced ailments. The geographical distribution for whites and blacks follows roughly the same pattern but the rates for blacks are two and half times higher. In the late nineteenth century blacks, who were then far more abstemious than whites, were strong supporters of the temperance movement, but the movement in the South was taken over by whites bent on disenfranchising black people by any means possible, such as propagating lurid tales of drink-crazed black men raping white women. Consequently, blacks became less involved in the temperance movement, a trend that accelerated early in the twentieth century with the great migration of blacks to the North, where liquor was freely available even during Prohibition.
The geographical pattern of mortality from the 12 conditions wholly caused by alcohol is partly explained by the average alcohol consumption among those who drink, which tends to be higher in the Southeast certain areas of the West and than elsewhere. In New Mexico, Arizona, Alaska, and in many counties in the Plains and Mountain states, the rates are high, in part, because of heavy drinking among Native Americans. Another possible contributor to high rates in the West is lower family and community support than elsewhere, as suggested by high divorce and suicide rates, low church membership, and the large number of migrants from other regions. In the South Atlantic states, black males contribute heavily to the high mortality rates, although white rates there are above average. One unexplained anomaly is the comparatively low rates in the area stretching from Kentucky through Tennessee, Alabama, Mississippi, to Louisiana, all states with high alcohol consumption among those who drink.
There were at least four cycles of high alcohol consumption in the last 150 years with peaks in the 1840s, in the 1860s, the first decade of the twentieth century, and again in the 1970-1981 period. Each of these peaks was probably accompanied by an increase in alcohol-related deaths, as suggested by the course of liver cirrhosis mortality, which, since the early twentieth century, has followed more-or-less the same trend as consumption of beverages alcohol. (Up to 95 percent of liver cirrhosis deaths are attributable to alcohol.) America is now in a phase of declining alcohol consumption, so one would expect that the rate of alcohol-related deaths would continue to decline. Among westernized countries, America in the early 1990s was somewhat below average in both alcohol consumption and liver cirrhosis mortality.
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