January 11, 2020 2:32 PM EST

Deaths from boozing and bingeing more than doubled in the past two decades, as alcohol consumption per person rose 8%, with sharp increases in the rate for women and the middle-aged.

Men were three-quarters of the total but fatalities for women rose at a faster rate: 85% versus 39% for males, according to 1999-2017 research by the National Institute on Alcohol Abuse and Alcoholism.

Total U.S. alcohol deaths reached 72,558 in 2017 — up from 35,914 in 1999 — with almost a third tied to liver disease, according to the study. Over 18 years, the total was almost 1 million.

“The report is a wakeup call to the growing threat alcohol poses to public health,” Director George Koob of the institute said Friday in a statement. “Alcohol-related deaths involving injuries, overdoses and chronic diseases are increasing across a wide swath of the population.”

Higher rates of deaths among middle-aged and older drinkers may raise concerns for public health experts, given projected growth the population of people 65 and older to 95 million in 2060 from 51 million in 2017. Alcohol accounted for 2.6% of all deaths in 2017.

“Even if rates of alcohol consumption and alcohol-related harms stay the same, the number of alcohol-related health-care visits and fatalities could increase substantially, thereby increasing the overall burden of alcohol on public health,” according to the research published in “Alcoholism: Clinical and Experimental Research.”

Women Dying

Among women, the highest rate of alcohol-related deaths in 1999 was among 65-to-74 year olds, followed by 55 to 64. By 2017, women aged 55 to 64 led, followed by ages 45 to 54. The annual increase of death for women jumped to 5.2% a year in 2010-17 from 2.1% a year in 1999-2010, the research-based death certificates showed.

“The rapid increase in deaths involving alcohol among women is troubling and parallels the increases in alcohol consumption among women over the past few decades,” Koob said.

The study said women were at greater risk for cardiovascular diseases, certain cancers, alcohol-related liver disease and acute liver failure from excessive drinking.

Researchers said further study of alcohol use over time between males and females and by age-groups, race, and ethnicity is needed “for understanding the public health burden of alcohol.”

People ages 45-74 had the highest death rate over the two decades, four times higher than those age 25-34, but the younger group had the largest average annual increase at 5.9%, the researchers said.

Emergency-room visits related to alcohol increased 76% in the 16 years ending in 2015. More women than men visited ERs with alcohol-related sicknesses, according to the study. The role of alcohol isn’t always clear when a death certificate is completed, making it difficult to measure the full magnitude of drinking and death, the study said.

The researchers led by Aaron White, senior scientific adviser to Koob, found the trends in drinking were different for men than for women.

While the prevalence of drinking and bingeing didn’t change for men, there was a 10.1% rise in the prevalence of drinking and a 23.3% increase in binge drinking among women.

Contact us at letters@time.com.

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