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

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%, <i>p</i> = 0.934), accelerated increase (2018-2021: APC = 18.35%, <i>p</i> = 0.036), followed by a modest decline (2021-2023: APC = -3.80%, <i>p</i> < 0.046). Female AAMR showed a higher APC (3.89%, <i>p</i> < 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 <i>p</i> < 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%, <i>p</i> = 0.004). White people accounted for most deaths (75.69%), with AMMR increasing continuously (APC = 3.45%, <i>p</i> < 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.