Background Due to lack of appropriate longitudinal data, relatively little is known about how and when persons who ultimately die due to alcohol-related causes interact with hospitals during the years before death. Using routinely collected nationwide data, we aimed to establish the timing and causes of all hospitalizations during a 10-year period before an alcohol-related death. Methods We traced back the timing and causes of all hospitalizations occurring during a 10-year period before death among men and women (n = 2,981) who were aged 35 and in employment at study entry, and who died from alcohol-related causes at ages 45 to 54 in 1997 to 2007. The study data consisted of 80% of all persons living in Finland who died during the study period. Those who died at ages 45 to 54 without alcohol involvement were used as a reference group. Results Persons who ultimately died from alcohol-related causes had on average 7 (mean 7.4, SD 9.9) hospital admissions, and they spent on average 56 days (mean 56.2, SD 105.1) in hospital during the study period. By the fifth year before death (from the year −10 to year −5), about three-fifths of these persons had been hospitalized due to any cause at least once, but less than one-third had a hospital admission with an alcohol-related diagnosis. Those who died without alcohol involvement had an average 9 hospital admissions (mean 9.3, SD 11.2), and they spent on average 81 days (mean 81.2, SD 163.9) in hospital during the study period. Conclusions The majority of employed middle-aged persons who ultimately died due to alcohol-related causes interacted with hospitals frequently and already several years before death. Additional research is warranted to evaluate whether enhanced patient management at hospitals targeted to this population could potentially reduce alcohol-related harms.