The global surge of cocaine use disorder: a 30-year burden analysis from the GBD 2021

Cocaine use disorder (CUD) represents a growing global health challenge with an inadequately characterized epidemiological profile. Utilizing data from the Global Burden of Disease (GBD) 2021 study across 204 countries or territories (1990-2021), this study assessed age-standardized incidence (ASIR), prevalence (ASPR), mortality (ASMR), and disability-adjusted life years (DALYs) rates. Key trends were analyzed using Estimated Annual Percentage Change (EAPC). Additional analyses included frontier mapping against the Socio-demographic Index (SDI), decomposition to identify driving factors, and ARIMA modeling for future projections. Findings revealed that global cocaine production tripled between 2009 and 2023, coinciding with a rising CUD burden: ASMR increased by 114% from 1990 to 2021, with males experiencing a faster mortality increase compared to females. High-income and Latin American regions bore the highest burden-the USA led in ASIR and ASMR, while Spain saw declines after 2005 due to stringent policies. SDI strongly correlated with ASIR (ρ = 0.59), and high-SDI regions had higher DALYs than low-SDI areas. Projections indicate accelerating ASMR and DALY rates in high-income countries by 2036. CUD imposes an escalating and inequitable global burden, disproportionately affecting males, high-income populations, and the Americas. Addressing this crisis requires targeted interventions and improved surveillance of evolving use patterns and comorbidities.