Burden, Trends, and Projections of Alcohol-Associated Liver Disease and Alcohol Use Disorder in the Asia-Pacific Region 1990-2040.
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BACKGROUND: Alcohol-associated liver disease (ALD) and alcohol use disorder (AUD) contribute significantly to the global disease burden, particularly in the Asia-Pacific region. This study evaluated trends in ALD and AUD across 39 Asia-Pacific countries from 1990 to 2021, with projections to 2040. METHODS: This study analysed age-standardised mortality, incidence, prevalence and disability-adjusted life years (DALYs) rates for ALD and AUD using GBD 2021 data, assessing correlations with SDI. Joinpoint regression identified temporal trends and inflection points, while age-period-cohort modelling decomposed independent effects of age, period, and cohort. ARIMA models projected burdens from 2022 to 2040. Alcohol-attributable risks were quantified via spatiotemporal regression and DisMod-MR 2.1 modelling, with population attributable fractions (PAFs) estimating alcohol-related disease burden. RESULTS: In 2021, the Southeast Asia (SEA) region exhibited a higher burden of alcohol-associated cirrhosis compared to the Western Pacific (WP), with age-standardised prevalence and mortality rates (ASPR and ASMR) exceeding global averages. Although the overall prevalence of AUD declined over the past three decades in both regions, notable fluctuations and periods of rebound were observed. In contrast, alcohol-associated liver cancer showed a continuous upward trend, particularly in WP countries with higher sociodemographic indices (SDI). Age-period-cohort analysis showed cirrhosis peaking at 65-75 years and AUD burden in both young adults and the elderly across SEA and WP, with a steady generational increase in alcohol-associated liver cancer seen in SEA. Major risk factors included childhood sexual abuse for AUD, and high body mass index and smoking for liver cancer. By 2040, alcohol-associated cirrhosis deaths may decline, but AUD and alcohol-associated liver cancer burdens are projected to rise or stabilise, especially in males. CONCLUSION: Targeted interventions and risk-stratified management are needed to address the growing burden of alcohol-associated liver diseases in the Asia-Pacific.