Improving Estimates of Alcohol-Attributable Deaths in the United States: Impact of Adjusting for the Underreporting of Alcohol Consumption.
Level 4 - case-series / case-control
Cross-sectional survey analysis combined with population-attributable fraction modeling.
PubMed 35040769 · doi:10.15288/jsad.2022.83.134
What was done
Researchers evaluated six methodological approaches to adjust self-reported average daily alcohol consumption (ADC) among U.S. adults from the 2011–2015 Behavioral Risk Factor Surveillance System (BRFSS; N = 2,198,089). Self-reported consumption was adjusted using data from the National Alcohol Survey, per capita alcohol sales data from the Alcohol Epidemiologic Data System, or both. These prevalence estimates across low, medium, and high ADC categories were then used to calculate annual alcohol-attributable deaths using a population-attributable fraction method.
What was found
Unadjusted BRFSS self-reported ADC covered 31.3% of per capita alcohol sales, rising to 36.1% using indexed-BRFSS data and 44.3% with National Alcohol Survey adjustments. Adjusting for per capita sales shifted population distributions away from low ADC and toward medium and high ADC categories. Consequently, estimated annual alcohol-attributable deaths increased from approximately 91,200 per year using unadjusted BRFSS data (Method 1) up to 125,200 per year when adjusted to 100% of per capita sales (Method 6).
Why it matters
Standard surveys substantially underreport alcohol intake compared with sales data, leading to systematic underestimation of excessive drinking and associated mortality. Incorporating sales-based adjustment models provides more realistic assessments of alcohol-related harms to inform public health policy.
Limits
The analysis relies on self-reported survey responses subject to recall and social desirability biases. Applying aggregate per capita sales data to individual consumption profiles requires modeling assumptions about the distribution of underreported intake that cannot be directly verified at the individual level.
Cited by
- supports Alcohol consumption causes approximately 150,000 deaths in the United States each year.