Global and regional burden of four drug use disorders in the elderly, 1990 to 2021: an analysis of the Global Burden of Disease Study

Background As the global population ages, the burden of drug use disorders (DUDs) among the elderly is rising. It is imperative to conduct a quantitative analysis of the disease burden affecting this vulnerable population. Methods Utilize the Global Burden of Disease Study 2021 database to obtain incidence rates and disability-adjusted life years (DALYs) for opioids, cocaine, amphetamines, and cannabis among the elderly (aged 60–89) across 204 countries and 5 SDI regions from 1990 to 2021. Employ Joinpoint regression analysis to calculate the average annual percentage change (AAPC) of age-standardized incidence rates (ASIR) and age-standardized DALYs rates (ASDR). Use the Das Gupta method to decompose and analyze the impacts of changes in age structure, population growth, and epidemiology on DALYs during this period. Finally, apply the Bayesian Age-Period-Cohort (BAPC) model to predict ASIR and DALYs for global and high-burden regions from 2022 to 2035. Results Of the four DUDs, opioids have the highest disease burden. Joinpoint analysis indicates that from 1990 to 2021, the ASIR for opioid use disorder decreased with an AAPC of -0.73 (95% CI: -0.79 to 0.67), while the ASDR remained stable. Cocaine use disorder ASIR remained stable, but ASDR increased with an AAPC of 0.94 (95% CI: 0.77–1.11). The burden of amphetamine and cannabis use disorders generally stabilized. Geographic heterogeneity was evident at regional and national levels, with ASDR for all four DUDs increasing in high-SDI areas while remaining stable or declining in other SDI areas. High-income North America, represented by the United States, shows a higher burden of disease. Decomposition analysis shows that population growth is the main factor affecting the change in the burden of DUDs in most regions, and high-income North America is mainly affected by epidemiological changes. According to the Predictive models, the DALYs of DUDs in the global elderly population is still on the rise, especially in the male group in North America. Conclusion The burden of DUDs among the elderly varies across countries, regions, SDI levels, and genders, underscoring the need for targeted public health policy adjustments and strategic allocation of medical resources to mitigate this burden.