Global burden and forecast of infectious diseases attributable to drug use: evidence from GBD 2021

Drug use is a significant risk factor for infectious diseases, yet a comprehensive global assessment of this burden-encompassing trends, inequalities, and forecasts-is lacking, hindering progress toward World Health Organization (WHO)'s 2030 elimination targets. This study provides the first such analysis, leveraging the Global Burden of Disease (GBD) 2021 study to quantify the specific burden of infectious diseases attributable to drug use.

Using data from 204 countries and territories in the GBD 2021 study, we analyzed deaths and disability-adjusted life years (DALYs) from HIV/AIDS, sexually transmitted infections (STIs), and other infectious diseases (primarily acute hepatitis B and C) attributable to drug use, following the GBD risk attribution framework. Methods included trend analysis, health inequality assessment, driver decomposition, age-period-cohort modeling, and Auto-Regressive Integrated Moving Average (ARIMA) forecasting to 2036.

From 1990 to 2021, the global age-standardized mortality rate (ASMR) for HIV/AIDS and STIs attributable to drug use increased by 135%, peaking around 2005 before declining, while the ASMR for other infectious diseases decreased by 57%. Males aged 30-54 carried the highest burden. Health inequality analysis revealed a shift of HIV/AIDS and STIs toward high-Socio-demographic Index (SDI) countries. Epidemiological changes were the primary driver of burden trends. By 2036, the ASMR for HIV/AIDS and STIs is projected to decline by 82.9%.

Drug use is a critical, evolving driver of infectious disease burden. Stratified interventions and coordinated supply-demand-side governance are essential to mitigate this burden and achieve global health goals.