Objective  To analyze the incidence and disease burden of substance use disorder (SUD) in China from 1990 to 2019, to evaluate the impact of different ages, periods and birth cohorts on the disease burden of SUD, and to predict disease burden of SUD from 2020 to 2034, so as to provide strategies for the prevention of SUD.

Methods  Based on the Global Burden of Disease Study 2019 (GBD 2019) database, the disease burden was described by incidence, years of life lost (YLLs), years lived with disability (YLDs) and disability-adjusted life years (DALYs). The Joinpoint regression model was used to analyze the trend of standardized incidence and standardized DALYs rate of SUD. Based on the age-period-cohort model, the age, period and cohort effects of SUD were discussed. The grey prediction model GM (1,1) was used to fit the trend of the incidence and standardized incidence of SUD and the trend of disease burden, and to predict the incidence and disease burden of SUD in 2020-2034.

Results  From 1990 to 2019, the standardized incidence of SUD of amphetamines [average annual percentage change (AAPC)=-0.9%] and cocaine (AAPC=- 0.5%) in China showed a downward trend (P<0.001), and the standardized incidence of SUD of cannabis (AAPC=0.9%) showed an increasing trend year by year (P<0.001). The trend of standardized incidence of opioid abuse disorders was not obvious (P>0.05). The DALYs rate caused by the 4 SUD showed a decreasing trend year by year (AAP_{Camphetamines}=-2.2%, AAPC_cocaine=-1.5%, AAPC_cannabis=-1.0%, AAPC_opioids=-1.0%, P<0.001). The results of age-period-cohort effect showed that the peak incidence of amphetamine, cocaine, cannabis and opioid use disorders was in the 25-30 age group. The DALYs rate caused by cannabis SUD increased with age, while the DALYs rates of amphetamines, cocaine and opioids SUD reached the peak in the 25-29, 30-34 and 35-39 age groups, respectively. The results of period effect showed that the risk of SUD in propylamines, cocaine and cannabis decreased first and then increased, while the risk of SUD in opioids increased and then decreased and increased again. The results of birth cohort effect showed that the risk of SUD of amphetamines, cocaine and opioids showed a decreasing trend as a whole except for a small fluctuation in individual birth cohorts. The risk of DALYs rate caused by SUD of amphetamines, cocaine and opioids showed a decreasing trend as a whole, while the risk of DALYs rate caused by SUD of cannabis showed an increasing trend year by year. The prediction results showed that the incidence of SUD of amphetamines, cocaine and opioids showed a downward trend from 2020 to 2034, and the incidence of SUD of cannabis showed a fluctuating upward trend. The DALYs attributed to SUD of amphetamines, cocaine, cannabis and opioids showed a decreasing trend year by year.

Conclusion  The disease burden of SUD in China is decreasing year by year in the future. The incidence and disease burden are affected by age effect, period effect and cohort effect to varying degrees. Early prevention and effective intervention are the key measures to control SUD.

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