The macroeconomic burden of four alcohol-attributable diseases in China increased markedly from 1990 to 2023, with alcohol use disorders consistently dominating and the burden overwhelmingly concentrated among males aged 35–64 years.
Key Findings
Results
The value of lost welfare (VLW) due to alcohol use disorders (AUD) in China increased from $1.84 billion in 1990 to $32.40 billion in 2023.
AUD consistently accounted for the highest VLW among all four alcohol-attributable diseases studied.
The increase represents more than a 17-fold rise over the 34-year period.
Joinpoint regression confirmed a continuously increasing trend with AAPC > 0 and p < 0.001.
Results are expressed in 2021 international dollars.
The VLW approach combined DALYs with age-adjusted value of a statistical life year (VSLY) estimates derived from willingness-to-pay methodology.
Results
The VLW due to alcoholic cardiomyopathy (ACM) increased from $0.04 billion in 1990 to $0.53 billion in 2023.
Joinpoint regression confirmed a continuously increasing trend with AAPC > 0 and p < 0.001.
The male-to-female VLW ratio for ACM was 14:1 in 2023, the highest ratio among all four diseases.
The age at peak VLW for ACM shifted from 35–39 years in 1990 to 50–54 years in 2023.
Results are expressed in 2021 international dollars.
Results
The VLW due to cirrhosis and other chronic liver diseases attributable to alcohol use (ALD) increased from $0.22 billion in 1990 to $3.26 billion in 2023.
Joinpoint regression confirmed a continuously increasing trend with AAPC > 0 and p < 0.001.
The male-to-female VLW ratio for ALD was 10:1 in 2023.
The age at peak VLW for ALD was 50–59 years.
Results are expressed in 2021 international dollars.
Results
The VLW due to liver cancer attributable to alcohol use (LCA) increased from $0.09 billion in 1990 to $2.48 billion in 2023, showing the most pronounced relative increase among all four diseases.
LCA showed the most pronounced increase among all four alcohol-attributable diseases studied.
Joinpoint regression confirmed a continuously increasing trend with AAPC > 0 and p < 0.001.
The male-to-female VLW ratio for LCA was 3:1 in 2023, the lowest ratio among all four diseases.
The age at peak VLW for LCA was 65–69 years.
Results are expressed in 2021 international dollars.
Results
Males predominated in the macroeconomic burden across all four alcohol-attributable diseases in China.
Male-to-female VLW ratios in 2023 were: 7:1 for AUD, 10:1 for ALD, 3:1 for LCA, and 14:1 for ACM.
The burden was overwhelmingly concentrated among males aged 35–64 years.
This pattern was consistent across all four diseases throughout the study period from 1990 to 2023.
Results
The age at peak VLW differed across the four diseases and, for ACM, shifted over the study period.
Peak VLW occurred at ages 35–39 years for AUD.
Peak VLW occurred at ages 50–59 years for ALD.
Peak VLW occurred at ages 65–69 years for LCA.
Peak VLW for ACM shifted from ages 35–39 years in 1990 to ages 50–54 years in 2023.
Results
Temporal trends in VLW for all four diseases were confirmed as continuously increasing by Joinpoint regression analysis.
All four diseases showed AAPC > 0.
All p-values were < 0.001.
DALY data from GBD 2023 spanning 1990 to 2023 were used as the basis for the analysis.
The study covered a 34-year period.
Results
Exploratory projections to 2030 using three models (ARIMA, XGBoost, and LightGBM) produced divergent forecasts for each disease.
Three models were used: ARIMA, XGBoost, and LightGBM.
Projections were described as 'exploratory' and 'conditional on the continuation of their respective historical trends.'
The three models produced divergent projections to 2030, indicating uncertainty in future burden estimates.
Forecasts were generated for all four diseases: AUD, ACM, ALD, and LCA.
Methods
The study used the value of lost welfare (VLW) approach, combining DALYs with age-adjusted VSLY estimates derived from willingness-to-pay methodology.
DALY data were extracted from GBD 2023 for the period 1990–2023.
VSLY estimates were age-adjusted and derived from willingness-to-pay methodology.
Results were expressed in 2021 international dollars and as a percentage of GDP.
This is described as the first study to quantify the macroeconomic burden of these four alcohol-attributable diseases in China from 1990 to 2023 with projections to 2030.
What This Means
This research examined the economic cost of four diseases caused by alcohol consumption in China over more than three decades (1990–2023): alcohol use disorder, alcoholic heart disease (cardiomyopathy), alcohol-related liver disease (cirrhosis), and alcohol-related liver cancer. To measure the economic cost, the researchers combined data on years of healthy life lost (DALYs) with estimates of how much society values a year of healthy life, expressed in 2021 international dollars. They found that the total economic burden of all four diseases grew dramatically over the study period, with alcohol use disorder alone rising from about $1.84 billion to $32.40 billion, and alcohol-related liver cancer showing the sharpest relative increase. The burden was heavily concentrated among men, with male-to-female cost ratios ranging from 3:1 (liver cancer) to 14:1 (heart disease) in 2023.
The research also found that the age groups hit hardest differed by disease: alcohol use disorder peaked in younger adults (ages 35–39), while liver disease and heart disease peaked in middle-aged adults (50s), and liver cancer peaked in older adults (65–69). Notably, the peak age for alcohol-related heart disease shifted from the late 30s in 1990 to the early 50s by 2023, suggesting changing patterns of alcohol-related harm over time. All four diseases showed consistently rising economic costs throughout the entire 34-year period. Projections to 2030 using three different forecasting methods suggested the burden will likely continue, though the models gave differing estimates of the exact magnitude.
This research suggests that the economic toll of alcohol-related diseases in China is substantial and growing, and that men in their working years (35–64) bear the greatest share of this burden. The findings point toward the potential value of prevention efforts targeting younger adults (ages 20–35) through health education and reduced alcohol availability, as well as screening and surveillance programs for middle-aged men—such as workplace-based screening for alcohol use disorder and combined liver-heart health monitoring for those aged 50–64. The study is notable as the first of its kind to comprehensively estimate the macroeconomic costs of these four specific alcohol-attributable diseases in China over this time span.
Yang X, Xin L, Yu J, Yang Q, Gong Y, Guo Z, et al.. (2026). The macroeconomic burden of four alcohol-attributable diseases in China, 1990-2023, and projections to 2030: results from GBD 2023.. Annals of medicine. https://doi.org/10.1080/07853890.2026.2741441