The rate of alcohol-related deaths in the United States has almost doubled in the past 20 years, according to a new study.

Men had higher overall alcohol-related death rates, while women experienced a larger relative increase, researchers from Florida Atlantic University found. They said this may reflect changing social norms and the alcohol industry’s increased targeting of women through marketing campaigns, HealthDay reports.

The researchers evaluated U.S. government data from 1999 to 2020 and found that the rate of alcohol-related deaths rose from 10.7 to 21.6 per 100,000. In 1999, there were 19,356 alcohol-related deaths, rising to 48,870 in 2020. Deaths rose in every age group. Among 25-to-34-year-olds, alcohol-related deaths rose almost fourfold.

“Health care providers should recognize that heavy alcohol use is a leading risk factor for total mortality and cardiovascular disease, especially heart attacks and stroke,” study co-author Charles H. Hennekens, M.D., said in a university news release. “To mitigate these risks, screening for alcohol use in primary care settings is essential.”