CDC - ARDI FAQ- Alcohol

General Information on the Alcohol-Related Disease Impact Application

Why are the ARDI estimates important?

The Alcohol-Related Disease Impact (ARDI) application generates estimates of alcohol-attributable deaths (AAD) and years of potential life lost (YPLL) due to alcohol consumption. These estimates provide vital information to better understand the health consequences of excessive alcohol use in the United States. In addition to estimating the national health effects of alcohol consumption, the ARDI application can produce state estimates of AAD and YPLL. Such state-specific analyses are useful because the prevalence of excessive alcohol use, particularly binge drinking, is known to vary substantially by location. State-specific estimates of alcohol-related health outcomes can better focus discussions of evidence-based public health strategies (e.g., increasing alcohol taxes, regulating the density of alcohol outlets, and alcohol screening and brief intervention) aimed at preventing consequences associated with excessive alcohol use.

Who is the intended audience for ARDI?

The primary audience for ARDI is state governments, particularly state health departments and state substance abuse agencies interested in determining the health impact of excessive alcohol use in their state for prevention, policy, and informational purposes. In addition, academic researchers will also benefit from using the ARDI application to estimate alcohol-attributable deaths (AAD) and years of potential life lost (YPLL) for research and analysis purposes.

The secondary audience includes those organizations involved with alcohol-related prevention and treatment programs, as well as state health policy organizations. These organizations include, but are not limited to, health-related nonprofit organizations, primary care associations, advocacy groups, as well as local boards of health, and city and county health departments.

Can ARDI be used to evaluate the effectiveness of public health programs?

ARDI is designed to estimate the health effects of excessive alcohol consumption over a specified period of time. Therefore, these estimates are not intended to be used to evaluate the effectiveness of public health programs or policies aimed at reducing alcohol consumption. Furthermore, these estimates are subject to year-to-year variations, which although reduced by using multiple years of data, are still subject to anomalies in the collection of mortality data that may not reflect changes in actual alcohol consumption resulting from public health programs.

Can ARDI be used to study trends over time in alcohol-attributable deaths (AAD) or years of potential life lost (YPLL)?

The ARDI application is used to assess average AAD or YPLL over a specified period of time. Customized analyses can be conducted using the Custom Data User Portal, including using other years of data.

Can I compare ARDI estimates published by CDC over the years to determine if the number of alcohol-attributable deaths has changed over time?

No, the estimates may not be comparable because CDC continues to improve the ARDI application and periodically updates the methods for calculating the average annual number of alcohol-attributable deaths nationally and in states. These changes are documented in the Announcements with each release of ARDI. For example, a new methodology was used with the release of ARDI estimates in 2022 to account for the under-reporting of alcohol use.

Can ARDI be used to compare my state’s alcohol-related outcomes to other states or national estimates?

The estimates provided in ARDI are the total number of alcohol-attributable deaths (AAD) or years of potential life lost (YPLL) for the location specified. To accurately compare states to each other or to national estimates, the AAD and YPLL must be adjusted appropriately to reflect differences in demographics between locations (e.g., regional differences in average age of the population). ARDI does not report adjusted AAD or YPLL; therefore, the estimates provided in the ARDI reports should not be compared across locations.

At the top of the reports, why is there a note indicating that the numbers may not sum to total due to rounding?

Rounding affects the numbers in the reports on alcohol-attributable deaths and years of potential life lost in a few different ways so that they may not sum to the totals. The annual average number of total deaths from each condition is calculated for each 5-year age grouping by sex, using a decimal point. The total death numbers are rounded to the nearest whole numbers after the alcohol-attributable fractions or relative risks are applied for calculating the alcohol-attributable deaths. The estimated numbers of alcohol-attributable deaths and years of potential life lost by cause of death are calculated as whole numbers and presented by sex and age group, as well as by sex-specific age groups. The sum of estimates from stratified views may not sum to totals.

Also, the sum of the estimates in the state reports may not equate to the US estimates because of: 1) rounding in the calculation of the alcohol-attributable deaths and years of potential life lost; and 2) the use of state-specific indirect alcohol-attributable fractions for estimating alcohol-attributable deaths from most chronic causes. The US reports are generated based on the national-level annual average number of total deaths from each condition rather than as the sum of the state estimates of alcohol-attributable deaths and years of potential life.

Why are some estimates of alcohol-related deaths suppressed?

To protect confidentiality, data are suppressed in cells with an estimate of fewer than 10 deaths or in which presenting data would provide information to derive the estimate for another cell that has fewer than 10 deaths.

Why does ARDI list some beneficial effects associated with alcohol consumption?

Overall, the ARDI data show that the harmful effects of alcohol outweigh any potential beneficial effects. Although alcohol is associated with increased all-cause mortality, alcohol consumption has been shown to reduce the risk of death from a limited number causes (e.g., gallbladder disease). For these causes, the relative risk estimates included in ARDI are less than one. When these estimates are used to calculate indirect alcohol-attributable fractions (AAF), the result is a negative AAF. When this negative AAF is then multiplied by the total number of deaths for that condition, the resulting number of deaths is negative. This indicates an estimated number of lives potentially saved from alcohol use at a particular consumption levels (e.g., low average daily alcohol consumption) for these causes. Some previous studies found that drinking at low levels might be good for your health for certain conditions. However, this is highly debated in scientific studies and now proving not to be true. The science is emerging about the effects of alcohol use on health and ARDI is updated periodically as new scientific studies become available.

Why are alcohol-attributable deaths (AAD) and years of potential life lost (YPLL) among people younger than 21 years described as being caused by “exposure” to alcohol?

The deaths among people younger than 21 years may result from an individual’s own drinking, or from the second-hand effects of someone else’s drinking (e.g., deaths from riding in a vehicle with an alcohol-impaired driver). Some causes of death in ARDI specifically affect infants and children (e.g., child maltreatment, fetal alcohol syndrome, and low birth weight) are entirely the result of another person’s (e.g., the infant’s mother’s) drinking.

How often are the data updated in ARDI?

Default data on deaths by cause, life expectancy, and prevalence of alcohol consumption are updated periodically. Risk estimates and alcohol-attributable fractions (AAF) are also re-examined periodically as new scientific estimates become available.