Global burden and cross-country inequalities of alcoholic cardiomyopathy: A 1990-2021 analysis

Alcoholic cardiomyopathy (ACM) remains a significant yet understudied contributor to global cardiovascular disease, with substantial socioeconomic influences on its epidemiology. This study investigates the global burden, temporal trends, and health inequalities of ACM across 204 countries.

Utilizing the Global Burden of Disease 2021 data (1990-2021), we analyzed age-standardised mortality (ASMR), prevalence (ASPR), and disability-adjusted life years (ASDR) for populations aged ≥15 years. A trend analysis employed the estimated annual percentage change (EAPC), while inequality metrics (Slope Index of Inequality, Concentration Index) assessed socioeconomic disparities using the socio-demographic index (SDI).

Globally, ACM caused 47,073 deaths and 2.19 million DALYs in 2021, with an overall decreasing trend (ASMR EAPC: -1.72 %). High-middle SDI regions bore the highest burden (ASDR: 88.27/100,000), particularly Eastern Europe (ASDR: 510.47). We identified a distinct nonlinear relationship with SDI: burden peaked at SDI≈0.75 (p < 0.001), with Eastern Europe showing the steepest rise/decline. Inequality analysis revealed persistent concentration in high-SDI regions (positive concentration indices: 0.51-0.60), though relative inequalities decreased over time. Kazakhstan exhibited the most rapid burden increase (ASMR EAPC: +11.15 %), while Southern Latin America showed maximal decline (ASMR EAPC: -6.69 %).

ACM disparities are strongly linked to socioeconomic development, highlighting the need for targeted alcohol policies in high-burden regions and equitable healthcare resource allocation.