Background Substance use, including tobacco, high alcohol use, and drug use, has negative consequences on the health, economy, productivity, and social aspects of communities. Understanding trends in the burden by age, over time, and location and sex is important for policymaking. This study aims to provide a comprehensive estimation of the global burden attributable to substance use. Methods Using data from the Global Burden of Disease study (GBD) 2021, we estimated the burden attributable to substance use in terms of the number and age-standardized rates (ASRs) of deaths and disability-adjusted life years (DALYs) from 1990 to 2021. Using histogram plots, world maps, and Pearson’s correlation analysis, we conducted a stratified analysis of substance use by sex, age, geographic location, sociodemographic index (SDI) level, and disease. Additionally, the Bayesian model for age-period-cohort was introduced to forecast the burden. Results In 2021, substance use was responsible for a substantial burden globally. From 1990 to 2021, the number of deaths and DALYs increased for nearly all substance use subtypes, while the age-standardized death rate (ASDR) and age-standardized DALY rate (ASDALYR) decreased. Furthermore, trends varied significantly by age, sex, geographic region, and SDI. The ASRs for all substance use subtypes were higher in male individuals than in female individuals, with the exception of secondhand smoke. Colder regions were associated with a higher burden attributable to high alcohol use, whereas the burden attributable to drug use increased with higher SDI levels. The burden attributable to chewing tobacco was notably more pronounced in South Asia than in other regions. Drug use disproportionately affected the 20–45 years age group. Projections indicate that the burden attributable to drug use and chewing tobacco will increase consistently from 2022 to 2040. Conclusion Substance use is an important contributor to the global disease burden. Population-specific interventions, including raising taxes, increasing price, formulating laws and regulations, and raising public awareness on the risks of substance use, should be implemented to prevent and reduce the substance use burden.
Zheng et al. (2026) studied this question.