Surveillance Report #120
APPARENT PER CAPITA ALCOHOL CONSUMPTION: NATIONAL, STATE, AND REGIONAL TRENDS, 1977–2021
Megan E. Slater, Ph.D.
Hillel R. Alpert, Sc.D.
CSR, Incorporated1
Suite 270
22375 Broderick Drive
Sterling, VA 20166
April 2023
U.S. Department of Health and Human Services
Public Health Service
National Institutes of Health
1 CSR, Incorporated, operates the Alcohol Epidemiologic Data System (AEDS) under Contract No. HHSN275201800004C for the National Institute on Alcohol Abuse and Alcoholism (NIAAA). Dr. Bradley Kerridge (Division of Epidemiology and Prevention Research) serves as the NIAAA Contracting Officer’s Representative on the contract.
HIGHLIGHTS
This surveillance report on 1977–2021 apparent per capita alcohol consumption in the United States is the 37th in a series of consumption reports produced annually by the National Institute on Alcohol Abuse and Alcoholism (NIAAA). Findings are based on alcoholic beverage sales data collected by the Alcohol Epidemiologic Data System (AEDS) from the States or from the National Alcohol Beverage Control Association and from various reports produced by beverage industry sources. Population data from the U.S. Census Bureau are used as denominators to calculate per capita rates.
The following are highlights from the current report, which updates consumption trends through 2021:
- Per capita consumption of ethanol from all alcoholic beverages combined in 2021 was 2.51 gallons, representing a 2.9 percent increase from 2.44 gallons in 2020 and a 5.5 percent increase from 2.38 gallons in 2019. This was the largest two-year increase since 1969, when there was a 5.9 percent increase (2.37 gallons in 1967 to 2.51 gallons in 1969).
- Between 2020 and 2021, changes in overall per capita ethanol consumption included increases in 37 States and the District of Columbia, decreases in 10 States, and no changes in 3 States.
- Analysis of overall per capita alcohol consumption by U.S. Census region between 2020 and 2021 indicated increases of 5.4 percent in the Northeast, 1.6 percent in the Midwest, 3.4 percent in the South, and 2.3 percent in the West.
- In 2021, State-level per capita annual alcohol consumption was more than 10 percent above the overall national level (> 2.76 gallons) in 17 States and the District of Columbia, 10 percent or less above the national level (> 2.51–2.76 gallons) in 5 States, up to 10 percent below the national level (2.26–2.51 gallons) in 15 States, and more than 10 percent below the national level (< 2.26 gallons) in 13 States.
INTRODUCTION
This surveillance report on apparent per capita alcohol consumption in the United States is the 37th in a series of reports that examine alcohol consumption trends on a national, State, and regional basis. Like previous reports on per capita alcohol consumption, it is intended to provide updated alcohol information for policymakers, health care providers, researchers, and others concerned about alcohol issues.
According to NIAAA (2022), a “standard drink” in the United States contains 0.6 fluid ounces of ethanol. Thus, the 2021 national annual per capita consumption level of 2.51 gallons of ethanol equates to a person aged 14 or older consuming approximately an average of 535.5 standard drinks in a year.
The current report updates the 1977–2020 alcohol consumption trends (Slater and Alpert 2022) with new data for 2021. Data are shown in four tables. Table 1 presents national data on trends in beer, wine, and spirits consumption as well as on all alcoholic beverages combined. Table 2 presents data on alcohol consumption for individual States for 2021. States also are ranked in deciles according to annual per capita ethanol consumption. Table 3 presents the alcoholic beverage sales and shipment data sources for the volume data presented in Table 2. Table 4 presents data on consumption trends for each type of beverage and all beverages combined for the States as well as for the four regions defined by the U.S. Census Bureau: Northeast, Midwest, South, and West.
DATA
Alcohol Consumption Data
AEDS makes every effort to obtain alcoholic beverage sales data from all States and the District of Columbia. AEDS prefers sales data to production and shipments data from beverage industry sources because sales data more accurately reflect actual alcoholic beverage consumption levels. States provide sales data in the form of volume or tax revenue that AEDS converts to gallons by using State tax rates. For 2021, AEDS received beverage sales and/or tax receipts reports from 33 States. AEDS also received spirits and wine sales data for alcoholic beverage control States from the National Alcohol Beverage Control Association. When State data were unavailable or unusable, AEDS used shipment data from beverage industry sources (Beverage Information Group 2022a, b, c) as a supplementary data source (Table 3). National and regional consumption data were estimated based on the sum of corresponding State-level volumes in gallons. The mixed use of data from sales and shipments sources appears to have little effect on overall trends in per capita alcohol consumption (Campbell et al. 1994; Haughwout et al. 2015). Some of the consumption estimates reported in the current report may differ slightly from those published in the previous year due to updates and revisions based on data received after publication. The types of data sources AEDS used to obtain alcohol consumption data are listed for years 2001–2021 in this report’s data file (https://www.niaaa.nih.gov/publications/surveillance-reports).
Population Data
AEDS obtained State population estimates for people ages 14 and older from the Centers for Disease Control and Prevention’s WONDER online query system, which provides population estimates produced by the U.S. Census Bureau (Single-race Population Estimates 2022; U.S. Department of Health and Human Services 2021). These data are used as denominators to calculate the per capita consumption figures.
To make the trend data more precise, AEDS revises data published in previous reports when the Census Bureau revises its population estimates. This report updates the 2010–2020 population estimates using revised estimates of the July 1 resident population from the Vintage 2020 and 2021 postcensal series (Single-race Population Estimates 2022).
METHODS
Conversion of Ethanol Content
AEDS uses an estimate of average ethanol content in the alcoholic beverages to convert the gallons of sold or shipped beer, wine, and spirits into gallons of ethanol (pure alcohol) before calculating per capita consumption estimates. For data years 1977–2021, the alcohol by volume (ABV; i.e., proportion of ethanol for each beverage type) values are 0.045 for beer, 0.129 for wine, and 0.411 for spirits (Doernberg and Stinson 1985). Following the ethanol conversions, gallons of ethanol for beer, wine, and spirits are summed to gallons of ethanol for all beverages.
AEDS has considered changes in the alcoholic beverage market over time that may affect the fixed ABV estimates used in this report (Martinez et al. 2019). Although changes in the average net ethanol content across all beverages are minimal (i.e., correlations between per capita consumption estimates derived from fixed and time-varying ABVs are >0.98 and >0.94 for national overall and beverage-specific estimates, respectively) and not large enough to alter the trends in overall per capita consumption (i.e., parallel trend lines since 1995 based on Joinpoint analysis), AEDS provides time-varying ABVs and corresponding gallons of ethanol in this report’s data file for comparison purposes (https://www.niaaa.nih.gov/publications/surveillance-reports).
The Alcohol Research Group provides AEDS with time-varying ABVs annually and derives the estimates for each beverage type based on three data components: (1) market shares for subcategories within the beverage type (e.g., table wine and wine coolers within wine); (2) market shares for leading brands in each subcategory; and (3) ethanol contents of these leading brands. These calculations follow the methodology developed by Kerr et al. (2006a, b) and most recently reported by Martinez et al. (2019).
Population Denominator
In this report, AEDS uses the population of people ages 14 and older to calculate per capita consumption rates. Although age 14 is below the minimum legal age for purchasing alcoholic beverages throughout the United States, most self-report surveys indicate that many people drink alcoholic beverages at age 14. For example, data from the NIAAA 2012–2013 National Epidemiologic Survey on Alcohol and Related Conditions indicate that 9.56 percent of current drinkers ages 18 and older in the United States began drinking at age 14 or younger (Chen et al. 2016). Results from the Monitoring the Future survey in 2021 (Johnston et al. 2022) indicate that 17.2 percent of eighth graders (students ages 13 to 14) reported past-year use of alcohol (i.e., beyond a few sips). Also, using data from the National Survey on Drug Use and Health 2017–2019, Chen and Yoon (2021) found the median age of initiation of alcohol use among people ages 12 to 20 to be age 14.9. Nonetheless, per capita consumption estimates for population ages 21 years and older are also provided in this report’s data file (https://www.niaaa.nih.gov/publications/surveillance-reports).
Estimation of Per Capita Ethanol Consumption
Per capita ethanol consumption rates for each beverage type are calculated by multiplying national, State, or regional beverage volume by the corresponding ABV and dividing by the national, State, or regional population ages 14 and older. Per capita ethanol consumption of all beverages is calculated directly from the estimated gallons of ethanol for all beverages divided by the population.
Percentage change calculations in this report are based on the numbers presented in the tables, which are rounded to two decimal places.
Per capita ethanol consumption rates based on the alternative time-varying ABVs can be derived from this report’s data file (https://www.niaaa.nih.gov/publications/surveillance-reports) by dividing gallons of ethanol consumed by the corresponding population of interest (i.e., ages 14 and older or ages 21 and older). For example, per capita consumption of ethanol from all alcoholic beverages combined in 2021 was 2.45 gallons (among ages 14 and older) using the time-varying ABVs.
Limitations
Readers familiar with survey reports and other scientific literature are accustomed to the presentation of significance tests, or confidence intervals, on any data comparisons or trends. However, because data presented in this report are based on total actual sales and/or shipments, AEDS does not provide measures of statistical significance. Nonetheless, it is important to note that these data are still only estimates and may be subject to reporting error and random fluctuation over time.
In addition to ABVs, many factors may result in inaccuracies of per capita alcohol consumption estimates. For instance, these estimates in some States may be inflated by such factors as cross-border sales to buyers from neighboring States (e.g., in New Hampshire) or tourist consumption of alcohol (e.g., in Nevada and Washington, D.C.). Other factors include variation in State reporting practices for sales of alcoholic beverages; time delay between State taxation records and actual consumption; exclusion of alcohol contained in medications and foods; unrecorded legal home production; and illicit production, importation, and sales (Rehm et al. 2014). These factors are discussed in detail in the AEDS data reference manual on per capita alcohol consumption (Nephew et al. 2004). Note that the word apparent in this report’s title is pertinent, because the estimates in this report are based on the reported volumes of alcoholic beverages released to the market for sale and not on actual measures of people’s alcohol consumption.
REFERENCES
Beverage Information Group. Beer Handbook, 2022. Norwalk, CT: Beverage Information Group, 2022a.
Beverage Information Group. Liquor Handbook, 2022. Norwalk, CT: Beverage Information Group, 2022b.
Beverage Information Group. Wine Handbook, 2022. Norwalk, CT: Beverage Information Group, 2022c.
Campbell, K.E.; Clem, D.; and Williams, G.D. Technical Report: 1986–91 Per Capita Ethanol Consumption Trends Using Beverage Industry Shipments Data Compared to Combined Sales/Tax Receipt and Shipments Data. Washington, DC: NIAAA, 1994.
Chen, C.M.; Slater, M.E.; Castle, I-J.P.; and Grant, B.F. Alcohol Use and Alcohol Use Disorders in the United States: Main Findings from the 2012–2013 National Epidemiologic Survey on Alcohol and Related Conditions-III (NESARC-III). NIH Publication No. 16-AA-8020. U.S. Alcohol Epidemiologic Data Reference Manual, Vol. 10. Bethesda, MD: NIAAA, 2016.
Chen, C.M., and Yoon, Y-H. Surveillance Report #116: Trends in Underage Drinking in the United States, 1991–2019. Bethesda, MD: NIAAA, 2021.
Doernberg, D., and Stinson, F.S. U.S. Apparent Consumption of Alcoholic Beverages Based on State Sales, Taxation, or Receipt Data (U.S. Alcohol Epidemiologic Data Reference Manual, Vol. 1). Washington, DC: U.S Government Printing Office, September 1985.
Haughwout, S.P.; Castle, I-J.P.; and LaVallee, R.A. Comparison of State Alcoholic Beverage Sales Data with Industry Shipment Data, 2001–2013: Apparent Per Capita Alcohol Consumption Surveillance Report Methodological Addendum. Bethesda, MD: NIAAA, 2015. Available at: https://www.niaaa.nih.gov/sites/default/files/m_addendum.pdf.
Hyman, M.; Zimmerman, M.; Gurioli, C.; and Helrich, A. Drinkers, Drinking and Alcohol-Related Mortality and Hospitalizations: A Statistical Compendium, 1980 ed. New Brunswick, NJ: Rutgers University, 1980.
Johnston, L.D.; Miech, R.A.; O’Malley, P.M.; Bachman, J.G.; Schulenberg, J.E.; and Patrick, M.E. Monitoring the Future National Survey Results on Drug Use, 1975-2021: Overview, Key Findings on Adolescent Drug Use. Ann Arbor, MI: Institute for Social Research, University of Michigan, 2022.
Kerr, W.C.; Greenfield, T.K.; Tujague, J.; and Brown, S.E. The alcohol content of wine consumed in the US and per capita consumption: New estimates reveal different trends. Alcoholism: Clinical and Experimental Research 30(3):516–522, 2006a.
Kerr, W.C.; Greenfield, T.K.; and Tujague, J. Estimates of the mean alcohol concentration of the spirits, wine, and beer sold in the United States and per capita consumption: 1950 to 2002. Alcoholism: Clinical and Experimental Research 30(9):1583–1591, 2006b.
Martinez, P.; Kerr, W.C.; Subbaraman, M.S.; and Roberts, S.C.M. New estimates of the mean alcohol content of beer, wine, and spirits sold in the United States show a greater increase in per capita alcohol consumption than previous estimates. Alcoholism: Clinical and Experimental Research 43(3):509–521, 2019.
National Institute on Alcohol Abuse and Alcoholism. Rethinking Drinking: Alcohol and Your Health. Bethesda, MD: National Institutes of Health, U.S. Department of Health and Human Services, 2022. Available at: https://www.rethinkingdrinking.niaaa.nih.gov.
Nephew, T.M.; Yi, H.; Williams, G.D.; Stinson, F.S.; and Dufour, M.C. U.S. Apparent Consumption of Alcoholic Beverages Based on State Sales, Taxation, or Receipt Data (U.S. Alcohol Epidemiologic Data Reference Manual, Vol. 1, 4th ed.). NIH Publication No. 04-5563. Bethesda, MD: NIAAA, 2004.
Rehm, J.; Kailasapillai, S.; Larsen, E.; Rehm, M.X; Samokhvalov, A.V.; Shield, K.D.; Roerecke, M.; and Lachenmeier, D.W. A systematic review of the epidemiology of unrecorded alcohol consumption and the chemical composition of unrecorded alcohol. Addiction 109:880–893, 2014.
Single-race Population Estimates, United States July 1st resident population by state, age, sex, single-race, and Hispanic Origin, on CDC WONDER Online Database. Vintage 2021 (2020–2021) estimates released by U.S. Census Bureau on June 30, 2022; Vintage 2020 (2010–2020) estimates released by U.S. Census Bureau on July 27, 2021. Available at: https://wonder.cdc.gov/single-race-population.html.
Slater, M.E., and Alpert, H.R. Surveillance Report #119: Apparent Per Capita Alcohol Consumption: National, State, and Regional Trends, 1977–2020. Bethesda, MD: NIAAA, 2022.
U.S. Department of Health and Human Services, Centers for Disease Control and Prevention (CDC), National Center for Health Statistics (NCHS). Bridged-Race Population Estimates, United States July 1st Resident Population by State, County, Age, Sex, Bridged-Race, and Hispanic Origin. Compiled from 1990–1999 bridged-race intercensal population estimates (released by NCHS on 7/26/2004) and revised bridged-race 2000–2009 intercensal population estimates (released by NCHS on 10/26/2012). Available on CDC WONDER Online Database at: https://wonder.cdc.gov/Bridged-Race-v2020.HTML.
List of Figures
Figure 1. Total per capita ethanol consumption, United States, 1935–2021.
Figure 2. Per capita ethanol consumption by beverage type, United States, 1977–2021.
Figure 3. Percentage change in per capita ethanol consumption, United States, 1977–2021.
Figure 4. Total per capita consumption of gallons of ethanol by State, United States, 2021.
Figure 5. Percentage change in total per capita ethanol consumption by State, United States, 2020–2021.
Figure 6. Total per capita ethanol consumption by region, United States, 1977–2021.
Figure 7. Per capita ethanol consumption from beer by region, United States, 1977–2021.
Figure 8. Per capita ethanol consumption from wine by region, United States, 1977–2021.
Figure 9. Per capita ethanol consumption from spirits by region, United States, 1977–2021.
List of Tables
Table 1. Apparent per capita ethanol consumption, United States, 1850–2021.
Table 2. Apparent alcohol consumption for States, census regions, and the United States, 2021.
Table 3. Sources of alcoholic beverages sales and shipment data by State and beverage type, 2021.
Table 4. Per capita ethanol consumption for States, census regions, and the United States, 1977–2021.
Figure 1. Total per capita ethanol consumption, United States, 1935–2021.
Figure 2. Per capita ethanol consumption by beverage type, United States, 1977–2021.
Figure 3. Percentage change in per capita ethanol consumption, United States, 1977–2021.
Figure 4. Total per capita consumption of gallons of ethanol by State, United States, 2021.
Figure 5. Percentage change in total per capita ethanol consumption by State, United States, 2020–2021.
Figure 6. Total per capita ethanol consumption by region, United States, 1977–2021.
Figure 7. Per capita ethanol consumption from beer by region, United States, 1977–2021.
Figure 8. Per capita ethanol consumption from wine by region, United States, 1977–2021.
Figure 9. Per capita ethanol consumption from spirits by region, United States, 1977–2021.
