Global and national trends in alcohol-attributable deaths from 1990 to 2023 and projections to 2050

The coronavirus disease 2019 (COVID-19) pandemic has been linked to increased alcohol-specific deaths. However, comprehensive global analyses of post-pandemic trends remain limited. Here, Global Burden of Disease 2023 data were used to describe temporal patterns in modelled alcohol-attributable mortality from 1990 to 2023, to identify temporal shifts coinciding with the pandemic period, and to project mortality rates from 2024 through 2050. Age-standardised mortality rates and estimated annual percentage changes (EAPCs) of alcohol-attributable deaths showed significant global variation. Liver cancer mortality increased modestly from 1990 to 2023 and is expected to rise gradually to 2050. A temporal shift in the trajectory of alcohol-attributable liver cancer mortality was observed, coinciding with the pandemic period: EAPC shifted from –0.74 (95% confidence interval: –1.25 to –0.23) before the pandemic (2016–2019) to 1.73 (95% confidence interval: 1.16 to 2.30) after the pandemic (2020–2023), with females experiencing larger absolute increases. Higher human development index and socio-demographic index correlated with rising liver cancer trends but decreasing cirrhosis mortality. The divergent association between development indices and mortality patterns by condition highlights the need for condition-specific surveillance and tailored interventions. Strengthening cancer screening pathways and addressing sex-specific vulnerabilities are urgent public health priorities to mitigate alcohol-attributable harm.