Researchers track how youth drinking deaths changed worldwide over 31 years

By Vijay Kumar MalesuReviewed by Susha Cheriyedath, M.Sc.Apr 6 2026

A 31-year global analysis shows youth alcohol-related deaths have fallen, but the toll remains strikingly high, especially among males and in countries where progress has lagged.

Study: Mortality attributable to youth drinking in 194 WHO member countries/territories, 1990–2021. Image Credit: Pressmaster / Shutterstock

In a recent study published in the journal Scientific Reports, a group of researchers analyzed trends and disparities in mortality attributable to youth drinking among individuals under 20 years across 194 WHO member countries and territories from 1990 to 2021.

Background

What if a preventable behavior were silently claiming thousands of young lives each year? The use of alcohol among youth is a global issue that has been associated with injury, violence, and long-term effects on health.

Despite legal restraints on drinking age, the exposure of young people to alcohol continues, and many adolescents throughout the globe continue to engage in some form of alcohol use. This harms brain development and also increases the chances of engaging in risk-taking behaviors, including aggression and unsafe driving.

Previous evidence indicates that alcohol is a major cause of mortality among young people; however, the patterns of alcohol-attributable mortality vary greatly throughout different areas of the world and among different populations. To develop effective prevention strategies, it is important to understand these trends, and further research is needed to ensure equal access to prevention resources.

About the study

The research used the Global Burden of Disease Study 2021 (GBD 2021) risk-attributable mortality data produced by the Institute for Health Metrics and Evaluation. The study examined mortality attributable to alcohol consumption in individuals under 20 years of age. The data were collected on all 194 World Health Organization (WHO) member countries and territories between 1990 and 2021.

Researchers calculated alcohol-related deaths using a structured risk assessment, and this involved mapping alcohol consumption levels, applying dose-response relationships, and calculating the proportion of deaths caused by alcohol.

Advanced statistical tools, including Spatiotemporal Gaussian Process Regression (ST-GPR), Cause of Death Ensemble modeling (CODEm), and Disease Modeling Meta-Regression (DisMod-MR 2.1), were used to generate the estimates. Results were based on 500 simulations, with uncertainty intervals reflecting statistical variation.

Researchers analyzed data by sex, socio-demographic index (SDI) levels, and cause of death categories according to the International Classification of Diseases, 10th Revision (ICD-10). Joinpoint regression was used to assess trends over time, yielding average annual percentage changes (AAPCs). Statistical significance was assessed by two-sided tests with a threshold of P < 0.05.

Study results

Between 1990 and 2021, alcohol consumption among individuals under 20 years contributed to an estimated 417,198 deaths globally. It was also noted that the total number of deaths declined from 13,346 in 1990 to 10,563 in 2021, but the burden remains high. This decline reflects an average annual reduction, suggesting gradual progress in prevention efforts.

There was a stark gender difference, as nearly 87% of deaths were male, with mortality rates 5.8 to 7.5 times higher than those of females. This difference may partly reflect increased prevalence of risk-taking behaviors, like dangerous driving and violence, among young males, and this highlights the potential value of gender-specific interventions.

Socio-demographic inequalities were also evident. Countries with high and high-middle SDI levels experienced the largest declines in mortality, with AAPCs of -2.71% and -2.06%, respectively. In contrast, low- and low-middle-SDI countries showed smaller declines or even increases.

In low-middle SDI settings, mortality increased by 31.8%, indicating widening global disparities. Limited healthcare access, weaker policy enforcement, and other public health priorities may explain these patterns. However, the paper also noted that high- and high-middle-SDI countries generally had the highest mortality rates over time, despite the largest declines.

The death causes linked to drinking among the young were dominated by preventable injuries. Transport injuries caused 36.1% of deaths, while violence (17.7%) and self-harm (13.5%) were other major causes. These findings suggest that alcohol may contribute to patterns of injury and violence that lead to fatal outcomes. It was also noted that in low SDI regions, respiratory infections and tuberculosis emerged as the leading causes, reflecting broader health system challenges.

China, Brazil, Russia, the United States, and India together accounted for 44.3% of all deaths, showing substantial geographic concentration in the burden. Mortality rates also varied widely between different countries, with some countries seeing decreases of over 90%, whereas other countries had seen increases of more than 700%. For example, Libya and Vietnam had very large increases, while Seychelles and Bhutan had very large decreases. Therefore, while global mortality rates have decreased overall, mortality rate changes have not been consistent across countries.

Conclusion

Alcohol-related deaths for people under 20 dropped slightly between 1990 and 2021, but the death toll is still high and unequal worldwide. People in many lower-income areas face a substantial and, in some cases, worsening burden, while most of these deaths are preventable, mostly resulting from traffic accidents and violence, showing a continued need for stronger prevention.

It is important to tighten alcohol laws, such as enforcing age limits, raising taxes, and limiting advertising. There is also a need for behavioral and policy interventions, particularly in lower- and middle-SDI settings with fewer resources. Accelerated implementation of global strategies can reduce preventable deaths and protect future generations. 

The authors also noted that their estimates depend on the quality of underlying GBD data and that the COVID-19 pandemic may have influenced mortality patterns in 2020 and 2021.