Mortality attributable to youth drinking in 194 WHO member countries/territories, 1990-2021

Youth drinking is known to be a leading and avoidable risk factor of mortality. However, recent evidence on mortality attributable to youth drinking on a global scale is limited. Using risk-attributable mortality data from the Global Burden of Disease Study 2021, we conducted a longitudinal analysis to examine trends in deaths and mortality attributable to youth drinking among individuals under 20 years across 194 WHO member countries/territories from 1990 to 2021. Mortality differences were assessed by sex, socio-demographic index (SDI) levels, and countries/territories. Average annual percentage changes (AAPCs) with 95% confidence intervals (CIs) estimated by Joinpoint regression were used to quantify significant mortality changes. A total of 417,198 deaths attributable to youth drinking were reported from 1990 to 2021, primarily from transport injuries (36.1%) and interpersonal violence (17.7%). The number of total deaths attributable to youth drinking declined from 13,346 in 1990 to 10,563 in 2021 (AAPC = -0.73%, 95% CI: -0.77% to -0.68%). Mortality among males was 5.8-7.5 times that of females. Large mortality decreases occurred over time in countries/territories with high (AAPC=-2.71%, 95% CI: -2.78% to -2.67%) and high-middle SDI (AAPC=-2.06%, 95% CI: -2.26%% to -1.87%%), while those with lower SDI levels showed relatively stable or slightly increasing mortality trends. The percent change in mortality varied greatly across the 194 WHO countries/territories from 1990 to 2021, ranging from - 96.8% (Seychelles) to 772.8% (Libya). Increases occurred in 30.4% of countries (59/194), all in low or middle SDI levels. Despite a substantial decline in mortality, therefore, youth drinking remains a global health challenge that disproportionally affect males and young adults in countries with low or middle SDI levels. Implementation of actions outlined in the WHO Global Alcohol Action Plan 2022-2030 should be accelerated and enhanced, especially in those countries with high attributable mortality rates as well as those experiencing large increases in mortality during between 1990 and 2021.