Alcohol-attributable cancer mortality in the United States, 1990–2023: a secondary analysis of Global Burden of Disease data

Background Alcohol consumption is known to be a significant risk factor for cancer. In 2025, the US Surgeon General recommended adding cancer risk warning labels to alcoholic beverages, emphasizing the need for increased awareness. However, national-level data describing long-term trends in alcohol-attributable cancer mortality, including variation by age, sex, and geographic region, remain limited. This study aims to evaluate trends in alcohol-attributable cancer mortality in the USA. Methods This was a population-based observational trend analysis using data from the Global Burden of Disease database. We analyzed age-standardized mortality rates (ASMRs) and the percentage of ASMR attributable to heavy alcohol use–defined as consumption exceeding the theoretical minimum risk exposure level, in the USA from 1990 to 2023. We evaluated ASMR for all cancers combined, followed by ten specific cancers. Results (per 100,000 population) were stratified by sex, location (50 states and Washington DC), and age-groups (20–54, 55 years and older). Joinpoint regression was performed using Monte Carlo permutation testing to select the optimal model; EAPCs were reported with 95% confidence intervals and two-sided p values. All rates are reported per 100,000 population. Findings Alcohol-attributable cancer deaths in the USA doubled from 1990 (11,361) to 2023 (23,126). Mortality rates were higher in the 55 years and older age-group (19.2; 95% CI, 12.8–28.7) versus 20–54 years (2.4; 1.4–3.4), and in males (6.4; 3.8–9.7) versus females (2.1; 1.4–3.0). The percentage of mortality attributable to alcohol increased across most cancer types, age groups, and sexes, with liver cancer demonstrating the greatest increase in alcohol-attributable (113.9%). In 2023, liver (12.7; 11.2–14.4) and breast (2.4; 0.9–5.9) cancers had the highest alcohol-related mortality rates in 55 years and older males and females, respectively; in ages 20–54, colorectal (0.9; 0.4–1.4) in males and breast (0.9; 0.5–1.4) in females were highest. State-wise, the District of Columbia recorded the highest (M: 9.8; 6.0–14.1; F: 3.5; 2.2–5.2), while Utah had the lowest (M: 3.9; 2.4–5.9; F: 1.4; 0.9–2.0) ASMR. Interpretation Alcohol-attributable cancer mortality has increased in the USA, with a disproportionate burden observed in males and 55 years and older individuals. Our findings highlight the critical need for targeted prevention efforts and increased awareness to address the rising impact of alcohol consumption on cancer-related mortality.