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Mortality directly attributable to alcohol has declined since the late 1990s recording a death rate of 5.1 per 100,000 persons in 2017, compared with 6.6 per 100,000 capita in 1997. In 2017, males aged between 60 and 64, dying from chronic alcoholic liver disease and living outside of a capital city were those most likely to die from a cause directly attributable to alcohol. This profile is similar to that in the late 1990s except the age of death has increased for both males and females. Although alcohol-induced mortality rates are declining, 2017 still recorded the largest number of deaths in this period, with 1,366 persons dying as a direct result of alcohol, indicating that alcohol consumption still causes significant burden within the Australian health system.

Alcohol related fatalities extend beyond those deaths which are directly attributable to alcohol. In 2017 there were 4,186 deaths where alcohol was mentioned as being a contributing factor to mortality. For deaths of females registered in 2017, a standardised rate of 7.0 deaths per 100,000 persons was recorded and represents the highest mortality rate of alcohol-related deaths for females in twenty years. Deaths due to injury, (including suicide, transport accidents and falls), were the most common underlying causes of death to have alcohol mentioned as a contributory factor. Across the population, younger Australians are more likely to have alcohol as an associated factor to death, often as a result of single occasion risky drinking (e.g. acute alcohol intoxication impaired judgement and influenced the death event), than the older population, who are more likely to have a chronic condition related to long term harmful alcohol consumption.

This article provides further information on alcohol-induced and alcohol-related deaths in Australia in 2017.

Defining an alcohol-induced and alcohol-related death

Alcohol can contribute to mortality in a number of different ways and deaths can be directly attributable or partially attributable to harmful levels of alcohol consumption. Deaths may arise from a chronic condition which is directly related to alcohol use such as alcoholic liver cirrhosis or from an acute condition directly related to harmful consumption such as alcohol poisoning which has led to respiratory depression. In Australia, deaths which are certified as being directly attributable to alcohol are coded as the underlying cause of death (the condition which initiated the train of morbid events). In this report, deaths registered in 2017 which are directly attributable to alcohol are referred to as "alcohol-induced deaths".

Alcohol may also play a significant role in a death, yet not be selected as the underlying cause of death. An example of this may be a death due to a motor vehicle accident where a person recorded a high blood alcohol concentration as measured in toxicology, or a death from hepatocellular carcinoma where a person may have demonstrated long term harmful levels of alcohol consumption. In both of these examples, the alcohol use would be referred to as an associated cause of death.

It is useful for understanding a more complete impact of a disease or behaviour to consider both underlying and associated causes of death in tandem. When deaths directly attributable to alcohol and deaths where alcohol were listed as an associated cause of death are considered together, they will be referred to as "alcohol-related deaths".

The Causes of Death, Australia report is an analysis of registered deaths and medical conditions listed on the Medical Certificate of Cause of Death (MCCD) in Australia in a given reference period (e.g. 2017). For this report, to be considered an alcohol-induced or alcohol-related death, reference to alcohol must be made on the MCCD by a practitioner for doctor certified deaths or within a police, toxicology, autopsy or coronial finding report for coroner certified deaths. There are many conditions which have strong associations with alcohol misuse and are considered partially attributable alcohol deaths, including mouth and oesophageal cancers, where a certifier may make no reference to alcohol misuse or contribution on the death certificate. These deaths will not be analysed within this report and it is acknowledged that this report is unable to provide a total attribution of fatal burden due to mortality in Australia. Rather, it provides an analysis of deaths where alcohol was certified in Australia for registered deaths in 2017.

For the purposes of this report, deaths are categorised as being alcohol-induced or alcohol-related through a tabulation of International Classification of Disease 10th edition (ICD) codes created by the Office of National Statistics in the United Kingdom. The tabulation consists of chronic health conditions, mental and behavioural conditions caused by alcohol abuse (e.g. addiction) and acute toxicity related deaths. Excluded from this article are deaths due to fetal alcohol syndrome (ICD-10 code Q86.0). In 2017 there were no deaths registered as being due to this cause. This article also does not cover types of alcohol consumed (i.e. beer, wine, spirits) which can provide important insights into alcohol consumption, however this information is generally not recorded on the MCCD.

Time series

Following a peak in the late 1990s, rates of alcohol-induced deaths declined during the 2000s, reaching a low of 4.5 deaths per 100,000 persons in 2012 and recording a preliminary rate of 5.1 deaths per 100,000 capita in 2017. Rates of alcohol-induced deaths per 100,000 persons have been stable in the 2013-2017 period. Consumption of alcohol has also decreased over time, with the Apparent Consumption of Alcohol Australia report 2016-2017, recording current rates of alcohol consumption at 9.4 litres per capita compared with 13.4 litres per capita in 1974-1975 (ABS).

Although rates of alcohol-induced deaths have declined significantly when compared with 20 years ago, the number of deaths recorded in 2017 was 1,366, which is the highest in the two decade time series (1,156 deaths in 1997).

The figure below shows a time series from 1997 to 2017 of age standardised death rates for alcohol-induced deaths per 100,000 persons. In addition to demonstrating the higher rates of deaths in the late 1990s, the data shows the consistently higher rates of alcohol-induced deaths in males. On average over the last two decades, the rate of alcohol-induced deaths for males has been 3.5 times higher than that of females. Although the number and rate of deaths is consistently higher in males (1,040 deaths in 2017), the rate of decline in mortality is more marked than that of females over the same period (27% from the peak point for males and 14% from the peak point for females).

The National Drug Strategy Household Survey 2016 (AIHW) found that males were more likely to consume alcohol daily or weekly, when compared with females. Males aged over 18 years were also more likely to be at greater risk for lifetime alcohol related harm and at risk of injury on a single occasion of drinking. However, males also reported a sharper decline in risky alcohol use (both lifetime and single occasion) over a 10 year period, aligning with the decline in mortality rates for alcohol-induced deaths.

Mental and behavioural disorders due to alcohol abuse, including alcohol addiction, accounted for a further 20% (approximate) of alcohol-induced deaths in 2017. Acute alcohol toxicity, alcoholic cardiomyopathy and other chronic conditions (e.g. alcoholic pancreatitis) comprised the remaining deaths.

The graph below highlights the similar compositions of alcohol-induced deaths for both males and females. Females had a slightly higher proportion of alcohol-induced deaths which were due to acute alcohol toxicity (7.5% of deaths compared with 5.8% of deaths for males).

Alcohol-induced deaths, by composition, by sex, 2017(a)(b)(c)

(a) Causes of death data for 2017 are preliminary and subject to a revisions process. See Explanatory Notes 57-60.
(b)The data presented for Alcohol-induced deaths is based deaths on an alcohol-induced death tabulation created by the Office of National Statistics in the United Kingdom. See Tabulation of selected causes of death (Appendix) in this publication for further details.
(c) Data presented in 'Other' includes ICD-10 codes E24.4, G31.2, G62.1, G72.1, K29.2, K85.2, K86.0 and R78.0. See Tabulation of selected causes of death (Appendix) in this publication for further details.


Age profile of alcohol-induced deaths

Males and females differ in their peak ages of death directly attributable to alcohol. The highest rate of death for males in 2017 was in the 80-84 year old age group (see below table), with a rate of 27.2 deaths per 100,000 population. The highest number of deaths for males was in the 55-59 year group with 168 deaths occurring in 2017. This is in comparison to females who recorded the highest number and rate of deaths in the 50-54 year old age group with 62 deaths and a mortality rate of 8.1 deaths per 100,000 persons. For both males and females deaths directly attributable to alcohol are rare before the age of 30.

Alcohol-induced deaths are a significant cause of premature mortality, with 26,205 years of life lost in 2017. On average, males lost 20.3 years from their life and females lost 22.7 years. The median age at death for males in 2017 was 60.1 years for males and 55.6 years for females. This is a slightly older profile than those who died from alcohol-induced deaths in 1997, when the median age at death was 58.3 years for males and 53.9 years for females. Premature mortality directly related to alcohol is perpetuated in many ways: harmful alcohol use is associated with adverse physical outcomes, including liver disease and alcohol poisoning leading to respiratory depression. Alcohol abuse is also linked to other effects such as the development of mental health conditions including anxiety and depression, and poor nutritional intake, which may in turn create new, or exacerbate, existing health issues.

Region of Usual Residence	no.	rate	proportion of region
New South Wales	458	5.2	100.0
Greater Sydney	235	4.3	51.3
Rest of NSW	223	6.4	48.7
Victoria	270	4.0	100.0
Greater Melbourne	175	3.4	64.8
Rest of VIC	92	5.2	34.1
Queensland	271	5.0	100.0
Greater Brisbane	118	4.6	43.5
Rest of QLD	152	5.3	56.1
South Australia	118	6.1	100.0
Greater Adelaide	77	5.1	65.3
Rest of SA	40	8.6	33.9
Western Australia	113	4.1	100.0
Greater Perth	82	3.8	72.6
Rest of WA	30	4.8	26.5
Tasmania	61	8.9	100.0
Greater Hobart	22	7.5	36.1
Rest of TAS	39	9.7	63.9
Northern Territory	39	16.7	100.0
Greater Darwin	14	9.0	35.9
Rest of NT	24	28.5	61.5
Australian Capital Territory	36	9.0	100.0
Capital Cities	759	3.5	55.8
Remainder of States	600	8.0	44.2
Australia	1366	5.1	100.0

Aboriginal and Torres Strait Islander males died from alcohol-induced conditions at five times the rate of Non-Indigenous males with a rate of 36.5 deaths per 100,000 persons (7.4 per 100,000 persons for non-Indigenous males). Indigenous females had a rate six times higher than that of Non-Indigenous females, and 1.7 times higher than that of Non-Indigenous males. The majority of Aboriginal and Torres Strait Islander alcohol-induced deaths were due to alcoholic liver diseases.

The prevalence of harmful alcohol use has been estimated to be at twice the level of that of Non-Indigenous persons (Wilson et al, 2010). Acknowledging the disproportionate harm experienced by Aboriginal and Torres Strait Islander persons due to drug and alcohol use, the Intergovernmental Committee on Drugs developed the National Aboriginal and Torres Strait Islander Peoples' Drug Strategy (a sub-strategy of the National Drug Strategy) with the aim of minimising harm associated with alcohol across communities and individuals. The Strategy outlines four priority areas to achieve harm reduction, focusing on building capability and capacity for alcohol and drug workforce's within communities, improving service accessibility, strengthening partnerships between government and Indigenous persons and developing meaningful measures. Risky alcohol consumption is a key health determinant measure detailed in the Health Performance Framework Report (PM&C).

Taking into account deaths directly attributable to alcohol, there were a total of 4,186 deaths in 2017 were certified by a doctor or mentioned in a coronial report as being alcohol-related. When looking at rates for alcohol-related deaths over the last 20 years (see graph below), the rate of death for all persons in 2017 is 15.9 deaths per 100,000 persons, the second highest in a twenty year time period. For females the rate of alcohol-related deaths is the highest in the time series. Alcohol was related to 2.6% of all deaths in Australia in 2017.

In contrast the proportion of alcohol-related deaths has a slower incline to the peak of 55 to 59, with a larger proportion of younger people likely to have an acute condition such as alcohol intoxication or harmful alcohol use certified at death. The median age for alcohol-related deaths is lower than that for deaths directly attributable to alcohol, at 56.0 years (compared to 59.1 for alcohol-induced) and on average, people lose 28.0 years from their life.

For those aged 75 years and over, ischaemic heart disease accounted for the underlying cause of approximately 10% of all alcohol-related deaths in 2017. Harmful consumption of alcohol can lead to lead to a raised level of triglycerides, a type of fat in the blood which are associated with high cholesterol and subsequently raise the risk of development of coronary artery disease. Cerebrovascular diseases such as stroke and diabetes, which share similar risk factors to coronary artery disease also had alcohol certified as a contributing factor in 1.6% and 1.3% of alcohol-related deaths respectively in 2017.

Government initiatives

Australia has implemented the seventh iteration of the National Drug Strategy (NDS), with the framework in place from 2017-2026. The strategy aims to minimise the harms associated with alcohol, tobacco and other drugs through demand reduction (delaying or preventing uptake of alcohol and drug use), supply reduction (e.g. preventing sale of alcohol to underage recipients) and harm reduction (e.g. reducing adverse health consequences for alcohol users). The strategy cites the importance of collaboration and partnerships both nationally and by jurisdiction to address alcohol and drug harm in Australia. The National Alcohol Strategy 2018-2026, a sub-strategy of the NDS is currently undergoing a consultation process. The aim of the National Alcohol Strategy will be to "provide a national framework to prevent and minimise alcohol-related harms among individuals, families and communities".

To reduce the risks related to drinking the National Health and Medical Research Council has created guidelines to reduce the risks from and help define, harmful drinking levels. The guidelines are as follows:

Guideline 1: Reducing the risk of alcohol-related harm over a lifetime
The lifetime risk of harm from drinking alcohol increases with the amount consumed.
For healthy men and women, drinking no more than two standard drinks on any day reduces the lifetime risk of harm from alcohol-related disease or injury.

Guideline 2: Reducing the risk of injury on a single occasion of drinking
On a single occasion of drinking, the risk of alcohol-related injury increases with the amount consumed.
For healthy men and women, drinking no more than four standard drinks on a single occasion reduces the risk of alcohol-related injury arising from that occasion.

Guideline 3: Children and young people under 18 years of age
For children and young people under 18 years of age, not drinking alcohol is the safest option.
A. Parents and carers should be advised that children under 15 years of age are at the greatest risk of harm from drinking and that for this age group, not drinking alcohol is especially important.
B. For young people aged 15−17 years, the safest option is to delay the initiation of drinking for as long as possible.

Guideline 4: Pregnancy and breastfeeding
Maternal alcohol consumption can harm the developing fetus or breastfeeding baby.
A. For women who are pregnant or planning a pregnancy, not drinking is the safest option.
B. For women who are breastfeeding, not drinking is the safest option.

For a complete outline of Australian Alcohol Guidelines and guidance to standard drink definitions in Australia please see the NHMRC Australian guidelines site.

For free and confidential advice about alcohol and other drugs, call the National Alcohol and Other Drug hotline on 1800 250 015. It will automatically direct you to the Alcohol and Drug Information Service in your state or territory. These local alcohol and other drug telephone services offer support, information, counselling and referral to services.

References

Australian Bureau of Statistics (ABS) 2018, Apparent Consumption of Alcohol, 2016-2017. Cat no. 4307.0.55.001.

Australian Institute of Health and Welfare (AIHW) 2017. National Drug Strategy Household Survey 2016.

Department of Health. National Drug Strategy 2017-2026.

Department of Health. National Aboriginal and Torres Strait Islander Peoples' Drug Strategy 2014-2019.

Department of Health. Consultation Draft. National Alcohol Strategy 2018-2026.

Department of the Prime Minister and Cabinet 2017. The Aboriginal and Torres Strait Islander Health Performance Framework (HPF).

Esang, M., & Ahmed, S. (2018). A closer look at substance use and suicide. American Journal of Psychiatry, 13(6), pp 6-8.

National Health and Medical Research Council 2009. Australian Guidelines to Reduce Health Risks from Drinking Alcohol.

Wilson, M., et al. (2010). The Harmful Use of Alcohol Amongst Indigenous Australians. Australian Indigenous Health Bulletin, 10(3), July-September.