Abstract
BACKGROUND: High alcohol use (HAU) is a major global public health concern, contributing to injuries such as Self-harm and interpersonal violence (SIV), Transport injuries (TI), and Unintentional injuries (UII). However, comprehensive global assessments of HAU-related injury burden remain limited. METHODS: Using data from Global Burden of Disease (GBD) 2021, we estimated HAU-related mortality and disability-adjusted life years (DALYs) from 1990 to 2021 across 204 countries and regions. We analyzed trends in Age-Standardized Disability-Adjusted Life Years Rate (ASDR) and Age-Standardized Mortality Rate (ASMR), examined Socio-demographic index (SDI) disparities, and employed age-period-cohort (APC) and Bayesian APC (BAPC) models for future projections. Frontier analysis identified countries with the greatest potential for burden reduction. RESULTS: Despite the decline in ASDR and ASMR in overall global injuries, Low-middle SDI regions continue to experience increasing SIV and TI burdens (ASDR rose from 57.25 to 70.55; 25.08 to 30.8 respectively), while UII remains high in High-middle and High SDI countries (The ASDR were 57.94 and 59.12 respectively). Young adults and the elderly bear the greatest burden. BAPC projections indicate that China, India, and several high-burden nations will see further increases in DALYs and ASDR by 2030, highlighting the need for urgent interventions. CONCLUSION: Targeted policy measures, such as raising the legal drinking age, strengthening alcohol control for young people in Low and Low-middle-SDI regions, and enhancing older adults healthcare services in High-SDI regions, are essential to mitigate HAU-related injuries. Evidence-based, SDI-adapted strategies can significantly reduce this burden.