Why some Oregon communities have high rates of alcohol-related deaths among older adults

Oregon communities have some of the nation’s highest rates of alcohol-related deaths among adults age 65 and older. That’s according to a new study conducted by the Woodlands Grove Recovery Campus in Ohio. It used CDC data from 2020 through 2024 to rank metro areas by both alcohol-induced death rates and total number of deaths.

Of the top 15 cities with the highest rates, six were in Oregon. Roseburg ranked second, Eugene-Springfield fourth and Medford fifth. Salem, Bend and the Portland-Vancouver-Hillsboro metro area also appeared in the top 15.

Dean Sidelinger is the chief health officer and state epidemiologist at the Oregon Health Authority. He joins us to talk about the dangers drinking can pose to older adults and what the state is doing to reduce alcohol-related deaths.

Note: The following transcript was transcribed digitally and validated for accuracy, readability and formatting by an OPB volunteer.

Dave Miller: This is Think Out Loud on OPB. I’m Dave Miller. Oregon communities have some of the nation’s highest rates of alcohol-induced deaths among adults 65 and over. That’s according to a new study that looked into CDC data. Of the top 15 cities with the highest death rates, six were in Oregon. Roseburg had the second highest rate in the country. Eugene, Springfield and Medford were fourth and fifth respectively. Salem, Bend, and the Portland metro area also appeared in the top 15. Dean Sidelinger is the state epidemiologist. He joins us now. It’s great to have you back on the show.

Dean Sidelinger: Thanks for having me.

Miller: So this study was based on CDC data about alcohol-induced mortality. What does that mean? What is alcohol-induced mortality?

Sidelinger: Yeah, thanks for that question. I think this data looked at death certificate data that’s compiled by the Center for Disease Control and Prevention that’s available publicly. An alcohol-induced death is one that’s caused by alcohol use. So think of something like liver failure, due to cirrhosis of the liver, so alcohol’s impact on the liver or someone who dies in a motor vehicle crash, who is intoxicated. So a death that we know we can trace directly to alcohol use, and that’s a subset of alcohol deaths. Broadly, alcohol causes nearly 3,000 deaths each year when we take into account that it contributes to many cancers and heart disease and other diseases. But either way we look at it, it’s a huge number of deaths here in Oregon and something that we can do something about.

Miller: Do the health effects of drinking vary by age?

Sidelinger: They certainly do. I think as we age, our body metabolizes alcohol differently, so it can have different effects on us as we age, maybe more profound effects. Also, for individuals who have a chronic condition or another disease, they can be impacted more profoundly than someone who doesn’t. And then many medications that we take interact with alcohol, and so they may not work as effectively or may have broader side effects. And as you likely know, many of those things accumulate with age. As we age, we’re more likely to have other chronic conditions. We’re also more likely to take medications, so those things together, and the cumulative effects of alcohol means that we do see greater effects in older Oregonians than we do in younger Oregonians.

Miller: How do other potentially negative hallmarks of aging or things that can happen as we get older – I’m thinking about isolation or depression – how might they play into this?

Sidelinger: Yeah, so certainly we don’t know exactly the relationship between all these things, but isolation and depression and kind of medicating or using alcohol as a way to get over some of those tougher times is certainly seen in older adults as well as other adults. The other contributing factor we may see is that percentage of populations in rural areas, they tend to skew older, may have less access or more difficult access to healthcare, so that can certainly contribute to more serious consequences and ultimately death when people don’t have convenient sources of care in their neighborhoods.

Miller: Is there good state data about just how much older Oregonians are drinking?

Sidelinger: So we have some data that we get from survey data that we go out each year and ask people to answer questions about their health, the behaviors that they take. And for 2024, which is the last year that we have data, we look at things like binge drinking and heavy drinking. So binge drinking is when people drink four or more drinks within two hours for women or five or more drinks within one hour for men. And what we saw is that adults 55 to 64, almost a little over 10% of them reported binge drinking, and then those adults over 65, about 5% reported binge drinking.

Looked at a different way, like over the week, we talked about heavy drinking, that’s eight or more drinks in a week for women, or fifteen or more drinks in a week for men. And those numbers are also high, so about 7% for those adults 55 to 64, and about 5% of adults 65 and older. So those two numbers for folks 65 and older are about 5%. There’s some overlap there, but that’s 1 in 20 older adults report some form of excessive drinking.

Miller: I want to pick up on that word “excessive” there. Is the public health message now that drinking can seriously and negatively affect your health well before binge drinking, well before, say, blacking out or or passing out?

Sidelinger: Yes, I think there’s negative impacts from alcohol use, even with small amounts of use. Those negative effects increase as you drink more or as you drink more at one time. So for example, the health impacts, for example, the contribution to cancer and other chronic conditions, those add up over time. So for people who drink regularly or who drink more heavily regularly, those add up. If you do things like binge drinking, where you drink excessively and you may become impaired, you’re more likely to have a motor vehicle crash or another accident that could lead to you being hurt or even dying.

So these things add up and so it’s not just folks who we would say are diagnosed with an alcohol use disorder who have potential health problems from alcohol. You can have potential health problems at much lower levels, and many people are surprised to learn that we define heavy drinking as eight or more drinks for women. So that’s just more than one a day, or fifteen or more drinks for men in a week. And we can see negative health impacts from that level of drinking, and many people might not consider that a health problem, so that’s why we’re out here talking about it. What are the impacts of alcohol on your health and what can you do if you decide, hey, I might want to drink less, to try and give people some clues so they can make those decisions for themselves.

Miller: So let’s turn to the inescapable question from this study. What are the reigning theories for why six Oregon communities are in the top 15 nationwide for alcohol-induced deaths among people 65 and older?

Sidelinger: Yeah, I wish I could give you a simple answer about what accounts for all of that, but I think the study wasn’t terribly surprising for those of us who know the data, because when we look at data about excessive alcohol use, those rates that people report to us on these annual surveys tend to be higher in Oregon than they are in many other states. We know that when we look at the health impacts of alcohol, even on a measure that we don’t want to see, like deaths, that about 3,000 people die with conditions attributable to alcohol, whether in part or fully each year, and about half of those deaths are in people 65 and older.

So as the population ages, certainly we’re going to see more people in the older age group and the effects of alcohol kind of accumulate over time. We also know, on the bright side, that we have slightly lower rates of deaths, or attributable to smoking and other things, and so that means that the alcohol percentage deaths look a little higher in Oregon. Alcohol is the third leading cause of preventable death in Oregon, so seeing these communities high on the list for those over 65 wasn’t too surprising, but it’s still a tragedy to think of our neighbors and friends and family dying from alcohol use.

Miller: Can you help me understand the potential connection there between the good news of Oregon having lower rates of death, say, from smoking and how that might… Are you saying that could artificially inflate the percentage of alcohol induced deaths?

Sidelinger: Well, yeah, because the effects of many of these preventable causes of death, whether it’s obesity and metabolic conditions, so things we think about like diabetes or the impacts of tobacco or the impacts of alcohol accumulate over time. So if we see less deaths due to those other conditions, that may mean more people are aging that are using alcohol, and eventually a percentage of them will likely have a condition that’s attributed to alcohol and may die from that. So that can cause that slightly higher piece, but certainly it’s likely also tied to those higher rates of use here in Oregon that we’ve seen for years and that’s why we want people to know about the negative health impacts of alcohol and what they can do if they choose to cut down and how they can do that.

Miller: You’re pointing out that surveys do show higher reporting of alcohol use among older Oregonians than people in other states maybe answers this question, and it’s possible I’m just looking for some way out of bad data, some way to not believe the numbers. But when I saw the numbers, I should say that I couldn’t help wonder if there’s something different about the way medical examiners or doctors are describing people’s deaths here, if we’re capturing data differently as a state and that could be part of an explanation for our wild overrepresentation on this national list. Is that possible?

Sidelinger: It’s possible, but not likely. So we work very hard in Oregon and in other states with physicians and providers, our medical examiners, on getting accurate causes of death on death certificates. The causes of death are fairly standardized, and are all reported up to the CDC and compiled by them in the system that these researchers looked at. These researchers looked at a subset of the alcohol deaths, and that’s alcohol-induced deaths, so these are deaths that are due to alcohol. Like I said, I gave an example of cirrhosis of the liver causing death. There’s a pretty standard way to determine if someone has cirrhosis of the liver and died from that. And so we can feel fairly confident that if that’s the cause of death on their death certificate, that it would be counted in this number.

Miller: And that people in Rhode Island would do it the same way, for example.

Sidelinger: Correct.

Miller: OK.

Sidelinger: Yeah, but like I said, death certificate data is not perfect, but each state works with providers to get the most accurate information that’s compiled the same across states and so those comparisons across states are pretty easy to make.

Miller: Can you remind us about OHA’s overall “Rethink the Drink” campaign that’s been going on now for a couple of years?

Sidelinger: Yeah, so we’ve seen this in the data, not just in older adults, but in Oregon, that deaths that are attributable to alcohol are higher than in many other states. So we wanted to get that information out to folks and “Rethink the Drink” communications is one way we do that. Again, to give information to people that alcohol can have negative health impacts, that alcohol is a carcinogen, can lead to many types of cancer, that alcohol can cause impairment, and you should not kind of drive a car because you’re more likely to be involved in a crash. So that people know what are the negative health impacts of alcohol.

What is excessive drinking? Again, those numbers of eight or more drinks for a woman in a week, or fifteen or more drinks for a man in a week, or more than four or five drinks in one sitting for a man or a woman are considered excessive and could lead to health impacts, even if done occasionally. So that people knew about, they could look then at their drinking habits, how often they drink, how much they drink, and determine for them, is this likely causing some health problems for me or could it lead to some health consequences down the line. And if it does, that they might consider cutting back or reducing their amount of alcohol by doing things like setting a plan before they go out, making sure they are counting their drinks, substituting non-alcoholic drinks with their alcohol drinks, and cut back if they so choose and have some resources that they could do, to do that or talk to their providers for extra help.

Miller: Dean, thanks very much.

Sidelinger: Thanks a lot.

Miller: Doctor Dean Sidelinger is the state epidemiologist for Oregon.

“Think Out Loud®” broadcasts live at noon every day and rebroadcasts at 8 p.m.

If you’d like to comment on any of the topics in this show or suggest a topic of your own, please get in touch with us on Facebook, send an email to thinkoutloud@opb.org, or you can leave a voicemail for us at 503-293-1983.