When it comes to drug-related liver disease, opioids usually get called out first as the driver of poor health outcomes. But a study out this month shows alcohol kills more people in the United States each year than heroin or prescription painkillers: Nearly 88,000 people die each year from drinking compared with the 72,000 people who die of opioid overdose, USA Today reports.

According to a new analysis by the Institute for Health Metrics and Evaluation at the University of Washington in Seattle, the number of deaths attributed to alcohol increased by 35 percent between 2007 and 2017, while the direct death rate rose by about 24 percent. The increase was particularly large among women, among whom death rates rose an astounding 85 percent. And while teen deaths from drinking decreased by 16 percent during the study period, deaths among adults ages 45 to 64 rose about 25 percent.

“The story is that no one has noticed this. It hasn’t really been researched before,” said study researcher Max Griswold, who helped develop the alcohol estimates. 

In fact, as USA Today reports, many women struggle with alcohol-related illness that goes unnoticed and untreated. The article also notes that binge drinking among middle-aged people has been increasing over the past few years. And those statistics, said study authors, mirror those of middle-aged women increasingly getting into trouble while drinking.

For example, according to a similar study published in the February 2018 issue of Alcoholism: Clinical and Experimental Research, which looked at emergency room visits from 2006 to 2014, the largest increases in admissions related to binge drinking were among middle-aged people, notably women. What’s more, these older patients tended to have more complications from their alcohol consumption—such as fluid buildup in their abdomens, liver cirrhosis, aspirated vomit in their lungs, brain hemorrhages and internal bleeding—than younger binge drinkers.

Experts say long-term drinking can also lead to an increased risk for heart failure, infections, dementia, stomach ulcers and cancer––conditions that aren’t really tracked among younger drinkers. And according to the Centers for Disease Control and Prevention alcoholism is three times costlier to treat than opioid addiction.

To learn more about alcohol-related liver disease, click here.