Supplementary file 1_Burden and trends of drug use disorders in young adults: global insights from GBD 2021.zip

BackgroundDrug use disorders (DUDs) is a serious global health crisis, particularly affecting adolescents and young people. The increasing prevalence of DUDs has led to the development of chronic diseases, including cancer, although it has significant impacts on health and life, it is often overlooked in research.
MethodThis study utilized GBD 2021 data to assess the burden of four drug use disorders in the young adult population. The data, covering 1991 to 2021, included metrics such as age-sex-year incidence, prevalence, deaths, and disability-adjusted life years (DALYs). Age-standardized rates were used for comparing burden across years and regions, and joinpoint analysis evaluated trends. The Bayesian Age-Period-Cohort model was employed to project future burden. The study also examined the relationship between DUDs burden and socio-economic conditions using the Social Development Index (SDI) and stratified data by WHO regions. Additionally, population attributable fractions were calculated within the GBD comparative risk assessment framework.
ResultsCannabis use disorder (CUDs) emerged as the most prevalent, the ASPR was 617.22/100,000 in 2021. The highest age-standardized mortality rates (ASMR) and age-standardized DALYs rates (ASDR) was observed in OUDs, at (1.46 [1.37-1.55]) and (236.61[185.21-292.47]), respectively. The region of the Americas accounted for the largest proportion of this burden. Opioid use disorders (OUDs) exhibited a notable rising trend, with the age-standardized prevalence rate (ASPR) of 359.62/100,000 in 2021, with a concentration primarily in the European region and the region of the Americas. Male had a higher burden of DUDs than female in the young adults. The burden of DUDs was mainly concentrated under the age of 25, especially CUDs and OUDs. The ASMR and ASDR of DUDs also showed significant growth trends in high SDI areas. Drug use’s contribution to cancer risk, particularly liver cancer due to hepatitis C virus (HCV), had been progressively increasing.
ConclusionsThe burden of OUDs and CUDs, continued to escalate annually, especially among young adult males who face heightened risks. Notably, drug use is increasingly contributing to liver cancer mortality and DALYs, emphasizing the urgency of interventions. This study provides evidence for evaluating the burden transfer between different demographic data.

背景：药物使用障碍（Drug use disorders, DUDs）是一场严峻的全球公共卫生危机，尤其对青少年与青年群体影响深重。当前DUDs患病率持续攀升，可引发包括癌症在内的多种慢性疾病，尽管其对健康与生命质量影响显著，但在相关研究中却常被忽视。
方法：本研究依托2021年全球疾病负担研究（GBD 2021）数据，评估青年人群中四类药物使用障碍的疾病负担。研究数据覆盖1991年至2021年，涵盖年龄-性别-年份发病率、患病率、死亡数及残疾调整生命年（disability-adjusted life years, DALYs）等指标。研究采用年龄标化率开展跨年份与跨区域的疾病负担对比，并通过连接点分析（joinpoint analysis）评估变化趋势；同时运用贝叶斯年龄-时期-队列模型（Bayesian Age-Period-Cohort model）预测未来疾病负担。此外，本研究借助社会发展指数（Social Development Index, SDI）分析DUDs疾病负担与社会经济状况的关联，并按世界卫生组织（WHO）区域对数据进行分层；同时在GBD比较风险评估框架内计算人口归因分数。
结果：大麻使用障碍（Cannabis use disorder, CUDs）是四类障碍中患病率最高的类型，2021年其年龄标化患病率（age-standardized prevalence rate, ASPR）达617.22/10万。阿片类药物使用障碍（Opioid use disorders, OUDs）的年龄标化死亡率（age-standardized mortality rates, ASMR）与年龄标化残疾调整生命年率（age-standardized DALYs rates, ASDR）均为最高，分别为1.46 [1.37-1.55]与236.61 [185.21-292.47]。美洲区域贡献了最大比例的此类疾病负担。OUDs呈现出显著的上升趋势，2021年其年龄标化患病率为359.62/10万，主要集中分布于欧洲区域与美洲区域。青年人群中男性的DUDs疾病负担高于女性。DUDs的疾病负担主要集中于25岁以下人群，尤以CUDs与OUDs为甚。在高社会发展指数（SDI）区域，DUDs的ASMR与ASDR均呈现显著增长趋势。药物使用对癌症风险的贡献，尤其是因丙型肝炎病毒（hepatitis C virus, HCV）引发的肝癌风险，正逐年升高。
结论：OUDs与CUDs的疾病负担逐年持续攀升，青年男性群体面临的风险尤为突出。值得注意的是，药物使用对肝癌死亡与DALYs的贡献正不断增加，凸显了开展干预措施的紧迫性。本研究为评估不同人口统计学维度下的疾病负担转移提供了实证依据。