Excessive drinking is the third leading preventable cause of death in the United States. According to research by the National Institutes of Health, alcohol was involved in 72,558 deaths in 2017, about 2.6% of all deaths in the country that year and more than double the number of alcohol-related deaths in 1999.

24/7 Tempo reviewed the percentage of men and women over 18 who reported heavy or binge drinking in each state’s metro areas. Only one metro area was considered in Delaware, New Hampshire, Rhode Island, and Vermont.

Metro level data was aggregated from the 2020 County Health Rankings & Roadmaps, a Robert Wood Johnson Foundation and University of Wisconsin Population Health Institute joint program.

Excessive drinking includes both binge and heavy drinking. Heavy drinking is defined as consuming at least 15 drinks a week or averaging two or more drinks a day for men, according to the CDC. For women, it’s eight drinks or more per week or more than one drink on average a day. Binge drinking is defined as a pattern of alcohol consumption that brings a person’s blood alcohol concentration level to 0.08% or higher — estimated to take about five or more drinks within two hours for men and four or more drinks for women.

Car accidents caused by alcohol-impaired people account for about 30% of all driving deaths in the United States.

Regular and excessive consumption of alcohol can result in chronic conditions and other long-term health problems, such as high blood pressure, heart disease, stroke, liver disease, and certain cancers. About half of alcohol-related deaths nationwide are due to liver disease or overdoses involving alcohol or alcohol combined with other drugs.

The percentage of Americans who drink liquor, wine, or beer occasionally has increased from 60% in 2014 to 65% in 2019, according to a Gallup poll from last year. America’s growing drinking population is reflected in consumer spending habits in some big cities — here is how much people spend on alcohol in 22 major American cities.

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On average, 19% of adult Americans report binge or heavy drinking, but the rates vary greatly from city to city and between states. For example, in Madison, Wisconsin, almost 28% of adults drink excessively, the highest share among all 383 U.S. metropolitan areas. In Provo-Orem, Utah, however, the rate is closer to 8%, the lowest among the nation’s metro areas.

Nine of the 10 cities with the highest excessive drinking rates are in Wisconsin. Most of the 40 metro areas with the highest rates of binge or heavy drinking are in the Midwest. By contrast, the cities with the lowest rates of excessive drinking are in the South. With the exception of Utah, most of them are in Tennessee, Alabama, Oklahoma, and West Virginia.

Within states, residents of urban areas almost always report higher excessive drinking rates than adults in non-metropolitan areas. The drunkest metro areas in four states — Delaware, Hawaii, New Hampshire, Wyoming — have lower excessive drinking rates than their respective states. Also, the drunkest cities in 12 states have lower excessive drinking rates than the country’s average of 19%.

Metro areas with higher rates of excessive drinking tend to be more affluent and have low unemployment rates. Of the 25 metro areas with the highest levels of binge or heavy drinking, only two had an unemployment rate higher than the U.S. average of 3.7% in 2019. Within states, only nine metro areas with the highest level of excessive drinking had a higher unemployment rate than the state average.