Global substance use disorders burden from 1990 to 2021: post-COVID shifts and widening inequalities.
Level 3 - non-randomized controlled study
Non-clinical/epidemiological modeling of longitudinal population data across 204 countries and territories (by design analogy).
PubMed 42026948 · doi:10.7189/jogh.16.04131
What was done
Researchers analyzed Global Burden of Disease (GBD) 2021 data covering 204 countries and territories from 1990 to 2021. They evaluated trends, age-sex patterns, and sociodemographic inequalities for substance use disorders (SUDs), alcohol use disorder (AUD), and drug use disorders (DUDs). Metrics reported included age-standardized prevalence rates (ASPR), incidence rates (ASIR), and disability-adjusted life-years rates (ASDR) per 100,000 population with 95% uncertainty intervals (UI), stratified across the Socio-demographic Index (SDI).
What was found
In 2021, an estimated 162.86 million people globally had SUDs (95% UI: 145.95 to 180.85). Global ASPR was 1982.13 per 100,000 (95% UI: 1773.57 to 2206.29), reflecting a 16.9% decline (95% UI: -18.7 to -14.9) since 1990. Global ASIR declined by 17.3% to 843.37 per 100,000 (95% UI: 736.21 to 956.19), and ASDR declined by 9.1% to 393.36 per 100,000 (95% UI: 323.56 to 469.04). AUD accounted for approximately 111.12 million cases (ASPR: 1335.43; 95% UI: 1153.65 to 1539.75) and DUDs for 53.12 million cases (ASPR: 663.80; 95% UI: 584.52 to 766.14). Geographic variation was wide: high-income North America recorded the highest ASDR (2193.48; 95% UI: 1861.45 to 2529.02), whereas Western Sub-Saharan Africa had the lowest (136.22; 95% UI: 108.18 to 170.26). DUD burden increased in several high-SDI areas during 2020–2021, peaked in individuals aged 25–35 years, and was consistently higher in males.
Why it matters
While age-standardized global rates have modestly decreased over three decades, absolute disease burden remains high and geographically unequal. The findings identify widening disparities and a sharp post-2020 increase in drug-related burden in high-income regions, underscoring the need for targeted harm-reduction and treatment strategies.
Limits
The analysis relies on secondary modeling from the GBD framework rather than direct longitudinal cohorts, which inherently depends on data completeness and varying surveillance quality across low- and middle-income regions. The abstract does not report specific drug classes or causal mechanisms driving the post-2020 shifts.
Cited by
- supports Men consume higher volumes of addictive substances across all global cultures and are overrepresented in all major addictions.