Alcohol-related deaths in the U.S. nearly doubled from 1999 to 2020. The sharpest spike occurred among 25–34-year-olds (nearly fourfold), while individuals aged 55–64 had the highest rates. Men consistently had higher rates but women saw the largest proportional rise, with deaths increasing 2.5 times. Asian and Pacific Islander communities experienced the steepest ethnic increase, while the Midwest saw the greatest regional rise (2.5 times), followed by the Northeast, West, and South.