What causes the excess rate of death associated with alcohol use disorders?

To what degree does the excess rate of death in individuals with alcohol use disorder (AUD) happen because of a predisposition in the person who develops AUD compared with the direct effect of the AUD itself?

That's the question Kenneth S. Kendler, M.D., of Virginia Commonwealth University, Richmond, and coauthors examined using Swedish registry information for members of the general population and half-siblings, full-siblings and monozygotic twins discordant (differing) on AUD, according to a new article published online by JAMA Psychiatry.

The authors report AUD was associated with excess mortality. The excess death associated with AUD appears to come from both the predisposition of the person who develops AUD and as a direct result of having AUD. The effect of predisposition to AUD was more prominent when people were younger and in the earlier years of AUD and the direct effect of AUD became more important later in life and later in the course of AUD.

"These results have clear implications for interventions that seek to reduce the substantially elevated rates of mortality in those with AUD," the authors conclude.