Alcohol and violent deaths in the United States, 2015-2022

This study describes alcohol involvement in violent deaths using the National Violent Death Reporting System (NVDRS) from 2015 to 2022 in 24 states where at least 90% of decedent records had available alcohol assessment data.

Using a repeated cross-sectional design, we construct a composite alcohol-involvement measure from toxicology results and NVDRS coder assessments and estimate negative binomial regression models with state-year demographic population counts as offsets to evaluate the roles of alcohol, firearms, and their intersection in violent deaths. The analytic sample included 204,739 decedents.

Alcohol was present in roughly 27% of all violent deaths (27% in suicide and 25% in homicide deaths), with age- and sex-adjusted alcohol-involved mortality rates ranging from 1.6 per 100,000 in Virginia to 7.8 per 100,000 in North Dakota. Firearms and alcohol co-occurred in 19% of homicide and 14% of suicide deaths. Alcohol involvement was most common among men and younger adults (aged 20-39) with the highest rates observed for men aged 30-39 who died from suicide. There was a slight (6%) decrease in mean alcohol-involved violent death rates within a subsample of 18 states observed from 2016 to 2022, although Alaska saw a larger decrease (39%) and Oregon and Connecticut saw a near doubling of their alcohol-involved violent death rates over this period.

These findings indicate that alcohol plays a substantial and complex role in violent deaths. This role differs between homicides and suicides, and varies by sex, age, state, year, and firearm involvement. Violence reduction efforts may benefit from interrupting the links between alcohol consumption and violent behaviors. Improved data collection and toxicology standardization across states would greatly enhance efforts to monitor and evaluate ongoing and future interventions.