Global burden, socioeconomic disparities, and spatiotemporal dynamics of opioid use disorder mortality and disability: a comprehensive analysis from the global burden of disease study 2017-2021

The escalating global burden of opioid use disorder (OUD) necessitates a nuanced understanding of its epidemiological patterns, socioeconomic determinants, and temporal trends. This study quantifies the global, regional, and national burden of OUD-related mortality and disability, evaluates policy correlates, and identifies critical disparities across demographic and socioeconomic strata. Using data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017–2021, we analyzed age-standardized mortality rates (ASMRs), disability-adjusted life years (DALYs), and their 95% uncertainty intervals (UIs) across 204 countries and territories. Joinpoint regression modeled temporal trends, while multivariable generalized estimating equations (GEEs) assessed socioeconomic gradients via the Socio-demographic Index (SDI). Geospatial clustering was evaluated using Moran's I statistic. Robustness was confirmed through sensitivity analyses, counterfactual modeling, and cross-validation. Globally, OUD mortality increased by 12.4% between 2017 and 2021, with the Americas remaining the epicenter (ASMR: 5.72 per 100,000; +47.3% deaths). Europe demonstrated progress (mortality decline: -1.8%), while Asia and Africa faced rising chronic disability (DALYs: +3.0% and + 10.2%, respectively). National-level extremes ranged from 0.01 per 100,000 in Japan to 7.16 per 100,000 in Canada. A pronounced socioeconomic gradient emerged: high-SDI regions exhibited 17.8-fold higher mortality rates (0.641% vs. 0.036% in low-SDI regions) and 13.9-fold greater DALY rates. Sex disparities persisted (male-to-female mortality ratio: 4.7:1), with males experiencing biphasic trends (+ 3.8% annual percent change APC pre-2020, -6.5% post-2020). Geospatial analyses revealed diverging trajectories, including rising mortality in the Americas (+ 4.2% APC) and declines in Africa (-3.1% APC). This study highlights stark regional and socioeconomic disparities in the OUD burden, exacerbated by synthetic opioid proliferation in high-income settings and chronic disability in resource-limited regions. Evidence-based harm reduction policies in high-SDI nations mitigated disability, while low-SDI regions faced accelerating crises. Targeted interventions addressing socioeconomic inequities, gender-specific risks, and geospatial vulnerabilities are urgently needed to curb the global opioid epidemic.