More people in the United States are dying from causes related to excessive alcohol consumption since 1999. Surprisingly, this is particularly true for American women, according to a study published July 28 in the journal JAMA Network Open. While men are roughly three times more likely than women to die from alcohol use, the gap has narrowed and the risk to women has grown recently.  

[Related: COVID lockdown drinking habits led to a rise in deaths from alcoholic liver disease.]

The study looked at Centers for Disease Control and Prevention (CDC) data on more than 600,000 deaths linked to alcohol between 1999 and 2020. The data included deaths from alcoholic liver disease, alcohol poisoning, acute intoxication, alcoholic cardiomyopathy, and mental and behavioral disorders that can be linked to alcohol consumption, and other causes.

It found that alcohol-related deaths steadily increased in the United States in that period. However, from 2018 to 2020, the rate increased by 14.7 percent for women compared to 12.5 percent for men. The study also found rising rates among older women in particular. Alcohol-related deaths rose in women over 65 and older by 6.7 percent from 2012 to 2020, compared with a 5.2 percent increase per year in men 65 and older. 

According to the authors, this shift does not necessarily mean that women in this age group are drinking more, but could point to “the larger burden of accumulating harms of chronic alcohol use among female individuals.”

While this study did not point to the reasons behind this increase, co-author and assistant professor of population health at Hofstra University Ibraheem Karaye offered a few potential theories to The New York Times. Karaye said that alcohol consumption is likely increasing among women and that alcohol affects women’s bodies differently. Women’s bodies typically have less fluid to dilute alcohol, which can result in higher blood-alcohol concentrations, which may make women more vulnerable to health complications, according to Karaye.

Stress is also a major factor in alcohol misuse among both men and women. The narrowing gap could reflect an increase in both stress and stress-related disorders among women, according to the team. 

[Related: A powerful combo of psilocybin and therapy might help people overcome alcohol use disorder.]

Excessive drinking during the COVID-19 pandemic has also increased alcoholic liver disease deaths, with a recent report from KFF Health News finding that the condition killed more Californians than car accidents or breast cancer. The lockdowns made people feel isolated, depressed, stressed, and anxious, says KFF’s Philip Reese, which led to some increases in drinking and an increase in alcohol sales.

Additionally, shifting attitudes towards heavy drinking by women may be a factor.  Associate professor in the division of gastroenterology and liver disease at NYU Langone Health Lisa Ganjhu told NBC News that she regularly sees women who are not aware of how physically toxic it can be. 

“The article didn’t surprise me. Women are overusing alcohol with more frequency now. I’ve had to talk to a fair number of women about their alcohol use,” said Ganjhu, who was not affiliated with the new study. “I had one patient who developed pancreatitis from drinking ask me when she could start drinking again. She said it wasn’t acceptable to not drink with clients. It’s mind-boggling.”

Regardless of gender, Karaye agrees with most physicians that “reducing or eliminating exposure [to alcohol] at any point would be valuable.” The National Institute on Alcohol Abuse and Alcoholism’s Rethinking Drinking program can help people evaluate alcohol usage and create plans to scale down or quit drinking.