Alcohol-related deaths have increased more than 100 percent in the past two decades, according to new research published in the journal Alcoholism: Clinical & Experimental Research.

Annual alcohol-related deaths for people at least 16 years old more than doubled between 1999 and 2017, from 35,914 to 72,558, with a total of almost 1 million alcohol-related deaths occurring during that period, according to the study. The majority of deaths were middle-aged men, but women are closing the gap, according to the study.

The authors specifically noted that women reach higher blood alcohol levels than men of similar weights after drinking the same amount, thereby exposing them to more alcohol and acetaldehyde, which is caused by partial oxidation of ethanol and contributes to hangovers.

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"Women are at greater risk than men at comparable levels of alcohol exposure for alcohol-related cardiovascular diseases, certain cancers, alcohol-related liver disease and acute liver failure due to excessive drinking," the study authors wrote.

The research found overall death rates were more than four times higher among middle-aged and elderly adults compared to those in their 20s and early 30s, and that alcohol-related emergency room visits increased among people over 65, which the authors attributed primarily to injuries caused by falls.

The authors also cautioned that their research was specifically based on data gleaned from reviewing death certificates, which sometimes contain incomplete information.

“Given previous reports that death certificates often fail to indicate the contribution of alcohol, the scope of alcohol‐related mortality in the United States is likely higher than suggested from death certificates alone. Findings confirm an increasing burden of alcohol on public health and support the need for improving surveillance of alcohol‐involved mortality,” they wrote.