Trends and disparities in the disease burden of stroke attributable to high alcohol use from 1990 to 2021 and projections to 2036: insights from the global burden of disease study 2021

Abstract Background: Despite being a significant modifiable risk factor for stroke, high alcohol use (HAU) lacks dedicated in-depth research on its attributable stroke burden. Using data from the Global Burden of Disease Study 2021 (GBD 2021), we assessed the spatiotemporal burden of stroke attributable to HAU to facilitate evidence-based policymaking and resource allocation. Methods: Our analysis focused on disability-adjusted life years (DALYs), deaths, and the age-standardized rates (ASRs) spanning from 1990 to 2021, with projections up to 2036 using Bayesian age-period-cohort (BAPC) models. Subgroup analyses were conducted on the basis of sex, age group, geographical region, and stroke subtype. Results: Globally, HAU-attributable stroke DALYs and deaths increased from 1990 to 2021, whereas the age-standardized DALY rate (ASDR) and the age-standardized mortality rate (ASMR) displayed decreasing patterns, with these trends projected to persist over the next decade. Compared with females and younger populations, males and the individuals aged 60 years and above consistently bore the majority of the disease burden. Notably, among the age groups under 35 years, there were significant upward trajectories in both DALY rates and mortality rates. In 2021, Vietnam recorded the highest ASDR 378.5 (95% UI: 84.09 to 688.25) per 100,000 and ASMR 16.22 (95% UI: 4.02 to 29.11) per 100,000, whereas the substantial disease burden in China positioned East Asia as the highest-burden GBD region. Driven by factors such as economic transitions, the middle- and low-middle socio-demographic index (SDI) regions, notably Southeast Asia, experienced the most pronounced upward trends in the ASRs. Intracerebral hemorrhage (ICH) was further confirmed as the predominant HAU-related stroke subtype. Conclusions: This study reveals the distribution characteristics and temporal trends of HAU-associated stroke burden among various regions and populations, underscoring the need for evidence-based interventions tailored to specific geographic and demographic contexts.