The hidden epidemic of alcohol-induced neurological and psychiatric mortality in the U. S. (1999–2023): trends and disparities

Background Alcohol use posed a significant burden to public health, contributing substantially to mortality from neurological and psychiatric disorders. Understanding trends and disparities in alcohol-induced neurological and psychiatric (AINP) mortality is crucial for informed policy and targeted interventions. Objectives This study is to analyze trends in AINP mortality and associated demographic and geographic disparities in the US between 1999 and 2023. Methods Data from the CDC WONDER database were collected to identify AINP related deaths via ICD-10 codes (F10, G31.2, G62.1). Age-adjusted mortality rates (AAMRs, per 100,000 population) and annual percent changes (APCs) with 95% confidence intervals (CIs) were calculated to assess temporal trends. An autoregressive integrated moving average model was used to predict mortality rate changes in high-risk populations by 2030. Results A total of 226,785 AINP deaths were reported. AAMR increased from 2.28 (1999) to 4.17 (2023), with no significant change (1999–2017: APC = −0.04%, p = 0.934), accelerated increase (2018–2021: APC = 18.35%, p = 0.036), followed by a modest decline (2021–2023: APC = −3.80%, p < 0.046). Female AAMR showed a higher APC (3.89%, p < 0.001) than males (2.55%). The Midwest showed the steepest APC (3.77%, p < 0.001), while the South and West showed the smallest increases (APC = 1.80 and 2.08%, both p < 0.01). Mortality growth rates rosed with increasing urbanization. American Indian/Alaska Native (AI/AN) populations had the highest AAMR, peaking at 21.13 in 2021 (APC 2.50%, p = 0.004). White people accounted for most deaths (75.69%), with AMMR increasing continuously (APC = 3.45%, p < 0.001)). Mortality peaked at ages 45–54 (crude rate: 7.86/100,000, 26.86% of deaths), 55–64 s most affected (30.98% of deaths). 56.85% of deaths occurred at home and 1.13% were pre-hospital. Female projections show a rising trend (APC 3.89%), while adults aged 45–74 show a slight decrease to 9.50 by 2030 despite a historical APC of 2.81%. Conclusions: From 1999 to 2023, US AINP mortality rosed steadily, disproportionately affecting females, AI/AN and White populations, Midwestern residents, and middle-aged and older adults. Most deaths occurred at home, reflecting healthcare access gaps. Targeted interventions for high-risk groups and regions, along with optimized medical resources allocation, are urgently needed.