Table 1_Global burden on drug use disorders from 1990 to 2021 and projections to 2046.pdf

BackgroundDrug use disorders (DUDs) continue to pose a heavy burden on individuals, families, and societies. Despite extensive research, there remains a paucity of comprehensive reports on the spatiotemporal distribution, driving factors, and future trends of DUDs at global, regional, and national levels. This study aims to address this gap by investigating these critical aspects of the DUDs epidemic.
Methods and findingsAnnual data on DUDs-related burden were collected from the Global Burden of Diseases, injuries, and risk factors Study (GBD) 2021. Age-period-cohort (APC) analysis and estimated annual percentage change were used to evaluate the spatiotemporal trend of burden. Decomposition analysis was used to identify the temporal and population-specific variations in the burden. The slope index of inequality and the concentration index were utilized to summarize health inequality of the burden. Frontier analysis was performed to evaluate the relationship between the burden of DUDs and socio-demographic development. The Nordpred model and Bayesian age-period-cohort (BAPC) model were introduced to forecast the burden. In 2021, the global prevalence of DUDs reached 53,115,936 (95% UI: 46,999,805–60,949,054), marking a 35.50% increase since 1990 and is projected to continue rising over the next 25 years. The increment in incidence, deaths, and disability-adjusted life years (DALYs) was 35.50%, 122.22%, and 74.65%, respectively. Despite the declining trends in global rates of incidence, prevalence, and DALYs, mortality still shows an upward trend, increasing from 1.26 to 1.65 per 100,000. Opioid and cocaine use disorders were the primary contributors to the overall increase in DUDs DALYs (82.07 and 59.57%, respectively). Population growth was the primary driver of the increase in DUDs DALYs (35.31%). A higher burden was observed in males and populations aged 15–39 years. Health inequality and insufficient healthcare performance regarding DUDs remain prominent issues in both high and low socio-demographic index (SDI) regions.
ConclusionsThis study underscores the persistent and evolving nature of DUDs. Future research should focus on understanding the complex interplay between age and gender disparities, socioeconomic development, drug policies, and DUDs burden to inform more effective global strategies.

背景 药物使用障碍（Drug Use Disorders, DUDs）始终给个体、家庭与社会带来沉重负担。尽管已有广泛研究，但目前仍缺乏针对全球、区域及国家层面药物使用障碍的时空分布、驱动因素及未来趋势的系统性综合报告。本研究旨在填补这一空白，对药物使用障碍流行的这些关键维度展开探究。
方法与结果 本研究从2021年全球疾病、伤害和风险因素负担研究（Global Burden of Diseases, Injuries, and Risk Factors Study, GBD）中获取了与药物使用障碍相关的年度负担数据。采用年龄-时期-队列（Age-Period-Cohort, APC）分析与估计年度变化百分比，评估负担的时空趋势；通过分解分析明确负担的时间与人群特异性差异；利用不平等斜率指数与集中指数，概括该负担的健康不平等情况；采用前沿分析评估药物使用障碍负担与社会人口学发展之间的关联；引入Nordpred模型与贝叶斯年龄-时期-队列（Bayesian Age-Period-Cohort, BAPC）模型对负担进行预测。2021年，全球药物使用障碍患病率达53115936（95%不确定区间：46999805~60949054），较1990年增长35.50%，预计未来25年仍将持续上升。发病率、死亡数与伤残调整生命年（Disability-Adjusted Life Years, DALYs）的增幅分别为35.50%、122.22%与74.65%。尽管全球发病率、患病率及DALYs率呈下降趋势，但死亡率仍呈上升态势，从每10万人1.26升至1.65。阿片类药物与可卡因使用障碍是药物使用障碍相关DALYs总体上升的主要贡献者（分别占82.07%与59.57%）。人口增长是药物使用障碍相关DALYs上升的主要驱动因素（贡献35.31%）。男性及15~39岁人群的疾病负担更高。在高、低社会人口学指数（Socio-demographic Index, SDI）区域，药物使用障碍相关的健康不平等与医疗服务绩效不足仍是突出问题。
结论 本研究凸显了药物使用障碍持续存在且不断演变的特征。未来研究应聚焦于阐明年龄与性别差异、社会经济发展、药物政策及药物使用障碍负担之间的复杂相互作用，为制定更有效的全球应对策略提供科学依据。