Global trends (1990-2021) and trojections to 2050 in alcohol-attributable epilepsy burden among adults over 40 years...

Epilepsy in Middle-aged and older adults has become a growing global health burden, with long-term alcohol consumption emerging as one of the key modifiable risk factors.

Leveraging comprehensive data from the Global Burden of Disease (GBD) 2021 study, we systematically evaluated mortality and morbidity metrics - including deaths, disability-adjusted life years (DALYs), years lived with disability (YLDs), years of life lost (YLLs), and corresponding age-standardized rates (ASRs) - across 204 countries and territories. Temporal trends from 1990 to 2021 were quantified using estimated annual percentage changes (EAPCs). For burden projections through 2050, we employed three complementary modeling approaches: Bayesian age-period-cohort (BAPC) analysis, autoregressive integrated moving average (ARIMA) modeling, and Exponential Smoothing (ES) techniques. Furthermore, we conducted decomposition analyses to differentiate the impacts of demographic shifts, population aging, and epidemiological transitions, complemented by comprehensive inequality assessments.

Globally in 2021, alcohol-related epilepsy accounted for 3,003 deaths (95% uncertainty interval [UI]: 2,116-3,933) and 241,378 disability-adjusted life years (DALYs; 95% UI: 157,104-345,001) among adults aged ≥ 40 years. The disease burden demonstrated significant gender disparities, with males bearing 2.1-fold higher age-standardized DALY rates (17.09 per 100,000 population) compared to females. Geographic analysis revealed distinct patterns: middle Socio-demographic Index (SDI) quintiles showed the highest absolute case numbers, while age-standardized rates exhibited a characteristic U-shaped distribution across the SDI spectrum. Temporal trends from 1990 to 2021 showed a 67.4% increase in mortality and 64.7% rise in DALYs, contrasting with a 14.5% decline in age-standardized rates (from 19.99 to 17.09 per 100,000).

Alcohol-related epilepsy represents a growing and substantial public health burden among aging populations worldwide, demonstrating pronounced disparities by gender, age, and geographic region. Our findings highlight the critical need for a dual intervention approach: implementing targeted alcohol control measures while developing tailored regional strategies to address demographic shifts and epidemiological risks. These results provide compelling evidence for prioritizing alcohol regulation within public health initiatives for aging societies.