A very interesting paper by researchers at Lighthouse Institute has been published in the journal called Public Health.
Here’s the citation and link to the article: Caroline B. Allen, Michael Dennis, Candace Mouton, Christine E. Grella. A comparative analysis of the most common causes of mortality and substance use by age, Public Health, Volume 257, 2026, 106306.
The paper examined cause-specific mortality patterns in US adults (ages 25 and higher) and youth (ages 24 and lower) during the calendar year 2022.
In this post I’ll provide a review of the article by quoting or summarizing key portions of the abstract, introduction, method, results, and discussion. And I’ll conclude with a comment of my own.
Abstract
There were 39,271 youth deaths (rate: 60.0 per 100,000) and 3,222,599 adult deaths (rate: 1402.9). Among youth, unintentional injuries (40%) and suicide (17%) predominated, whereas adults were dominated by heart disease (22%) and cancer (19%). Overall, 20% of youth deaths involved alcohol or drugs compared with 6% of adult deaths. Substance involvement ranked second by share among youths versus sixth among adults. Conclusions: Youth mortality is disproportionately driven by preventable external causes, frequently involving alcohol and drugs. Targeted prevention addressing substance use, injury reduction, and mental health is critical to reducing premature deaths.
Introduction
Although individuals aged 10–24 account for only a small fraction of US deaths, their causes of death are largely preventable and differ markedly from those of older adults: youth are predominantly affected by external causes of injury and violence, whereas older adults more often succumb to chronic diseases.
Unintentional injuries and suicides consistently rank as the top causes of adolescent deaths….only about 10% of adolescents with substance use disorders receive any form of care, compared with roughly half of those with a diagnosed mental health condition, underscoring a critical gap between mortality burden and treatment access.
Alcohol-impaired driving remains a leading factor in teen motor vehicle fatalities, with about one in three US crash deaths involving teen drivers over the legal alcohol limit. Even moderate intoxication significantly raises crash risk among adolescents. Beyond impaired driving, early substance use increases vulnerability to a range of adverse outcomes, including unintentional injuries, exposure to violence, and the onset or exacerbation of mental health crises.
Methods
The authors reviewed the Multiple Causes of Death (up to 20 total) for each case record. And they extracted the relevant ICD-10 codes for those causes – both those that were designated as an underlying cause and those that were a contributing factor.
To assess substance involvement, we created four mutually exclusive indicators by scanning all 20 MCOD fields: alcohol only, drug only, both alcohol and drugs, or neither. ‘Drug involvement’ included unintentional poisonings, suicides by poisoning, and poisonings of undetermined intent. ‘Alcohol involvement’ was identified via alcohol-related mental/behavioral disorders and organ-specific conditions and alcohol poisoning.
Results
Breaking down youth substance-involved deaths, the majority were drug-only: 6493 cases (rate 9.9). Alcohol-only deaths were uncommon: 515 cases (rate 0.8), consistent with the rarity of chronic alcohol-related conditions in youth. Another 829 (rate 1.3) youth deaths involved both alcohol and drugs, showing combined exposures added a smaller but consequential share.
Among adults, 207,697 of 3,222,599 deaths (6%; rate 90.4 per 100,000) involved AOD. While absolute numbers were vastly higher in adults, ‘Any AOD’ ranked second among youth causes by share (20%) versus sixth among adults (6%). This contrast underscores the outsized role of alcohol and drugs in shaping youth mortality patterns, in particular the dominance of drug involvement.
Examination of AOD involvement within specific cause categories revealed that among youth, 40.3% of accident deaths and 48.4% of liver disease deaths involved substances. Notably, for several medical conditions, including hypertension (10.5%), influenza/pneumonia (10.7%), respiratory disease (10.3%), and diabetes (9.9%), AOD involvement was 2 to 4 times more prevalent in youth than in adults dying from the same causes. Among drug-only deaths, polydrug involvement (multiple drug types) predominated in both youth (86.4%) and adults (80.8%). Opioid involvement was present in 9.1% of deaths at ages 10-17, rising to 19.9% at ages 18-24 and 20.3% at ages 25-49, before declining to 1.0% at ages 50 and older. Stimulant involvement followed a similar but later-breaking pattern (2.7%, 9.5%, 15.2%, and 1.0%, respectively).
Discussion
The authors note that youth mortality is “overwhelmingly driven by preventable causes” with alcohol and drugs having an “outsized” role.
They break this down in some detail by pointing out that adults account for a “vast majority of substance-involved deaths” in total raw numbers. But they clarify by also stating that for all adult deaths, alcohol and drug involvement was at a 6% rate, while it was one death in five among youth.
Further, they point out that this includes alcohol and other drugs as a factor in 10% of youth deaths from causes such as diabetes, respiratory disease, and influenza/pneumonia. And alcohol itself, they note, is a contributor in injury-related mortality among youth, including a “substantial share” of fatal motor crashes, drowning, falls, violence, and suicide.
Conclusion
The authors concluding by stating,
Our comparative analysis of 2022 US mortality data shows that adolescents and young adults face a fundamentally different mortality profile than older adults, with deaths dominated by preventable external causes, especially unintentional injuries, suicides, and substance-related incidents. Alcohol and drugs contribute to one in five youth deaths, underscoring the urgency of prevention and treatment tailored to this age group. Reducing youth mortality will require prioritizing interventions targeting external causes and substance use, including safe driving programs, overdose prevention, mental health screening, and firearm safety measures. These interventions can yield disproportionate gains in years of life saved, ensuring that preventable tragedies in adolescence and early adulthood are reduced through targeted, evidence-based public health action.
What are my two cents?
I really appreciate this paper.
I only wish the causes of death among youth examined not only the alcohol and drug use of the youth themselves (as a causal or contributing factor), but also looked at the alcohol and drug use of the parents instead of the youth.
For example, in some families, the mortality of the child includes parental alcohol or drug use as a cause or as a contributing factor.
And that’s one of my reasons for thinking that family members (including youth) should be included as stakeholders in planning SUD services, addiction treatment, and harm reduction strategies for the adults in the home.
Suggested Readings
“Harms of Use”: A List of References. October 24, 2019.
The Four Pests: recovery, sobriety/abstinence, addiction illness, and treatment. March 11, 2021.
Birth-Related Defects in the Alcoholic Family System. September 11, 2021.
Study Betel Nut Before You Finalize Your Public Health or Harm Reduction Policy. December 10, 2021.
The Effects of Paternal Alcohol Use Prior to Conception. April 22, 2023.
A brain-imaging study of the family members of people with alcohol use disorder. September 22, 2024.
