Drug use disorders have become a major global public health challenge, threatening people's health, increasing the disease burden and hindering economic development and social progress. As the burden of disease varies among different drugs, preventing and controlling them has become a major concern for all sectors of society.

To analyse the trend in the disease burden of drug use disorders in China between 1990 and 2021. This includes calculating the age-standardised incidence and DALY rates of drug use disorders and their five subcategories, and making predictions about the incidence and DALY rates from 2022 to 2046. These findings will provide a scientific basis for policy formulation and intervention implementation.

Data from the Global Burden of Diseases 2021 (GBD 2021) database was extracted, including age-standardised incidence rates, disability-adjusted life years (DALY) rates for drug use disorders and five subcategories from 1990 to 2021 (Opioid use disorders, Cannabis use disorders, Cocaine use disorders, Amphetamine use disorders and Other drug use disorders). Joinpoint regression models were used to analyse the age-standardised incidence rates and the annual percent change(APC) and average annual percent change(AAPC) in DALY rates. Bayesian age-period-cohort prediction models were used to predict trends in age-standardised incidence and DALY rates from 2022 to 2046.

Joinpoint regression analysis revealed an overall downward trend in the age-standardised incidence and DALY rates of drug use disorders in the Chinese population from 1990 to 2021 (AAPC values of -0.76% and -2.75%, respectively, both P<0.05). The age-standardised incidence and DALY rates of drug use disorders showed an overall downward trend for both males and females (AAPC values of -0.69% and -2.50% for males, and -0.85% and -3.09% for females, respectively; both P<0.05). Among the five subcategories of drug use disorders nationwide, the age-standardised incidence and DALY rates of cannabis use disorders showed an overall increasing trend (AAPC=0.66%, 0.71%, respectively; both P<0.05). The age-standardised incidence and DALY rates of the remaining four subcategories showed an overall decreasing trend (Opioids: AAPC=-1.97%, -3.41%; Amphetamines: AAPC=-1.50%, -1.66%; Cocaine: AAPC=-0.66%, -2.12%; Other: AAPC=-0.64%, -3.83%; all P<0.05). The Bayesian age-period-cohort prediction models predicted that from 2022 to 2046, the incidence and DALY rates of drug use disorders in both male and female populations in China would increase. The projected increase in incidence was approximately 50.80% for males and 24.27% for females, with a higher increase in males than females. The projected increase in DALY rates was approximately 48.34% for males and 41.46% for females, with a higher increase in males than females.

From 1990 to 2021, the disease burden of drug use disorders in China decreased, with males bearing a higher burden than females. With the exception of Cannabis use disorders, the remaining four subcategories of drug use disorders showed an overall downward trend. The burden due to Opioid use disorders was the most severe. However, it is projected that, from 2022 to 2046, age-standardised incidence and DALY rates will increase.

药物滥用障碍已成为全球性公共卫生挑战，威胁人们生命健康，加重疾病负担，制约经济发展和社会进步。不同药物滥用所引发的疾病负担存在差异，明确防控重点已成为各界关注焦点。

分析1990—2021年中国药物滥用障碍疾病负担变化趋势，包括药物滥用障碍及5个子类疾病年龄标准化发病率、伤残调整寿命年（DALY）率，并预测2022—2046年中国药物滥用障碍发病率和DALY率变化趋势，为政策制定与干预措施的实施提供科学依据。

利用2021年全球疾病负担数据库（GBD 2021）的数据资料，提取1990—2021年中国药物滥用障碍及5个子类（阿片类药物滥用障碍、大麻滥用障碍、可卡因滥用障碍、安非他明滥用障碍和其他类药物滥用障碍）疾病年龄标准化发病率、DALY率。采用Joinpoint回归模型分析年龄标准化发病率、DALY率年度变化百分比（APC）和平均年度变化百分比（AAPC）。采用贝叶斯年龄-时期-队列预测模型预测2022—2046年年龄标准化发病率、DALY率的趋势。

Joinpoint回归结果显示，1990—2021年全国人群药物滥用障碍年龄标准化发病率和DALY率整体均呈下降趋势（AAPC值分别为-0.76%和-2.75%，P均<0.05）；男性和女性药物滥用障碍的年龄标准化发病率和DALY率整体均呈下降趋势（男性AAPC值分别为-0.69%和-2.50%，女性分别为-0.85%和-3.09%，P均<0.05）；全国5个子类药物滥用障碍中除大麻滥用障碍年龄标准化发病率、DALY率整体呈上升趋势外（大麻：AAPC分别为0.66%、0.71%，P均<0.05），其余4个子类药物滥用障碍年龄标准化发病率、DALY率整体均呈下降趋势（阿片类药物：AAPC分别为-1.97%、-3.41%，安非他明：AAPC分别为-1.50%、-1.66%；可卡因：AAPC分别为-0.66%、-2.12%，其他类药物：AAPC分别为-0.64%、-3.83%，P均<0.05）。贝叶斯年龄-时期-队列预测模型预测结果显示，2022—2046年中国男性和女性人群药物滥用障碍年龄标准化发病率、DALY率均呈上升趋势，男性发病率增幅约为50.80%，女性约为24.27%，男性增幅高于女性；男性DALY率增幅约为48.34%，女性约为41.46%，男性增幅高于女性。

1990—2021年中国药物滥用障碍的疾病负担呈下降趋势，男性疾病负担高于女性；除大麻滥用障碍外，其余4个子类药物滥用障碍的疾病负担整体呈下降趋势，其中阿片类药物滥用障碍所致的疾病负担更严重；预测2022—2046年年龄标准化发病率、DALY率呈上升趋势。