The national and provincial disease and indirect economic burden of high alcohol use in China from 1990 to 2023 with forecasting to 2050

Background High alcohol use, defined as consumption exceeding the theoretical minimum risk exposure level, poses a major public health challenge in China, yet comprehensive long-term estimates combining disease burden and indirect economic burdens are limited. This study quantified national and subnational trends in disease and indirect economic burdens attributable to high alcohol use in China from 1990 to 2023 and forecasted the high alcohol use-related indirect economic burden to 2050. Methods Disease burden data were obtained from the Global Burden of Disease Study 2023. Economic parameters were sourced from the China Statistical Yearbook 2024, the Penn World Table, and the Seventh National Population Census. The indirect economic burden was estimated using a cost-of-illness model. The estimated annual percentage change (EAPC) was calculated to assess trends (1990−2023) in age-standardized mortality and DALY rates, as well as productivity losses due to premature death, morbidity, and total indirect economic burden. Spatial distributions of all-cause burden and the top six leading diseases (ranked by DALYs) were compared between 1990 and 2023. Sex and age-specific patterns were analyzed using absolute DALY numbers and indirect economic burden values. Finally, the Bayesian age-period-cohort model was used to forecast productivity losses due to premature death and morbidity, along with the total indirect economic burden to 2050. Results National age-standardized mortality rate attributable to high alcohol use declined from 27.68/100,000 [95% uncertainty interval (UI) 13.17−48.69] in 1990 to 10.58/100,000 (95% UI 4.60−19.26) in 2023 (EAPC=−3.02%, 95% UI −4.15 to −1.85; P <0.01), and the age-standardized DALY rate attributable to high alcohol use declined from 1012.53/100,000 (95% UI 567.90−1565.46) to 492.91/100,000 (95% UI 311.38−751.27) (EAPC=−2.26%, 95% UI −3.05 to −1.52; P <0.01). Corresponding indirect economic burden as a percentage of Gross Domestic Product (GDP) decreased from 0.15% (95% UI 0.13−0.18) to 0.13% (95% UI 0.11−0.16) (EAPC=−0.47%, 95% UI −0.77 to −0.17; P <0.01). High disease burden consistently clustered in Southwest and North China, while high economic burden mainly concentrated in East and Southwest, with notable regional mismatches. Burden was higher in males than in females, and the age profile of indirect economic loss shifted toward older working-age adults. Forecasts indicated that the overall indirect economic burden as a percentage of GDP reached a nadir around 2039 (EAPC=0.12%, 95% UI 0.10–0.14), before rising to 0.14% (95% UI 0.12–0.21) in 2050. Conclusions From 1990 to 2023, age-standardized mortality and DALY rates attributable to high alcohol use declined substantially in China, and the indirect economic burden as a share of GDP decreased modestly, despite marked growth in absolute productivity loss. Subnational heterogeneity persisted among different regions. Forecasts of the indirect economic burden indicate a nadir around 2039, followed by a subsequent increase with uncertainty.