Background: Following the COVID-19 pandemic, many countries saw large increases in rates of alcohol-specific deaths, including England. This study aimed to examine whether there have been changes in the characteristics of those dying by specific cause of death, age, sex, and area-level deprivation.

Methods: Using annual mortality data in England published by the Office for National Statistics, we describe the prevalence and 95% CI of age-standardised rates of alcohol-specific deaths overall and by age, sex, area-level deprivation measured by quintiles of the Index of Multiple Deprivation (IMD), and cause of death between 2001 and 2022. We also compared demographic profiles of those dying before the COVID-19 pandemic (2017–19) and after (2020–22); calculated crude absolute differences in rates and relative rate ratios across age, sex, and IMD; and used a multivariable Poisson regression model to calculate the rate ratio and adjusted absolute differences for deaths by IMD quintile for each period, adjusting for age and sex.

Findings: Age-standardised rates of alcohol-specific deaths in England remained largely unchanged until 2019, before rising sharply by 19·4% in 2020 and continuing to rise by a further 13·5% to the highest level on record in 2022: 14·7 (95% CI 14·4–15·0) per 100 000 people. There were few relative demographic changes in alcohol-specific mortality between 2017–19 (pre-pandemic) and 2020–22 (after the start of the COVID-19 pandemic) because the largest absolute increases in alcohol-specific mortality were seen among groups that had the highest pre-pandemic rates, including men (absolute rate increase, 3·87; relative increase, 25·9%) and those from areas of higher deprivation (absolute rate increase, 4·72; relative increase, 22·5%). When examining causes of deaths, the largest absolute increase was in alcohol-related liver disease (2·37; relative increase, 27·2%), with the largest relative increase in acute causes (absolute rate increase, 0·49; relative increase, 35·4%), although these accounted for a smaller proportion of deaths compared to alcohol-related liver disease. There was little to no change in deaths from alcohol dependence syndrome (absolute rate increase, 0·02; relative increase, 5·8%).

Interpretation: Alcohol-specific deaths in England remain high and increased after the COVID-19 pandemic. Policies should aim to reduce rates of alcohol consumption at the population level. Substantial investment is also required to facilitate early detection of liver disease and effective treatment.