The rising tide of opioid use disorder: analyzing 30 years of epidemiological trends and socioeconomic factors in the U.S.

Opioid Use Disorder (OUD) has emerged as a severe public health crisis in the United States (U.S.), with its disease burden significantly exceeding the global average and exhibiting a continuous upward trend. However, existing research predominantly focuses on general Drug Use Disorder (DUD), lacking specialized epidemiological analyses of OUD, particularly concerning regional distribution, gender differences, and socioeconomic influencing factors. This study systematically assesses the burden of OUD in the U.S. and its spatiotemporal evolution characteristics based on the Global Burden of Disease (GBD) 2021 data, providing a basis for targeted prevention and control policies. Utilizing the GBD 2021 data, we extracted indicators of OUD incidence (Age-Standardized Incidence Rate, ASIR), prevalence (Age-Standardized Prevalence Rate, ASPR), mortality (Age-Standardized Mortality Rate, ASMR), and Disability-Adjusted Life Years (DALYs) for each state in the U.S., analyzing their age, gender, and geographic distribution characteristics. Joinpoint Regression was employed to identify temporal trends in disease burden and calculate the Average Annual Percent Change (AAPC). An Autoregressive Integrated Moving Average (ARIMA) model was used to forecast future trends in disease burden while analyzing the correlation between the Socio-Demographic Index (SDI) and OUD indicators. From 1990 to 2021, the burden of OUD in the U.S. was significantly higher than the global level, and the gap continued to widen. The burden was greater in males than in females, particularly in mortality rates (ASMR: 22.78 for males vs. 10.77 for females). Age distribution revealed a peak incidence in the 20-24 age group, while mortality peaked in the 30-40 age range. West Virginia and its surrounding areas represented high-burden hotspots (with the highest ASMR reaching 42.85). Temporal trend analysis indicated the fastest growth in disease burden from 2010 to 2018 (AAPC = 5.48-7.88, P < 0.05). In 2021, a negative correlation between SDI and ASIR was observed (ρ = -0.338, P = 0.015), suggesting a higher incidence of new cases in socioeconomically disadvantaged areas. The ARIMA forecast indicated that by 2036, ASMR could increase by 71.37%, while ASPR and DALYs may decline slightly. The burden of OUD in the U.S. exhibits significant gender, age, and regional disparities and is closely related to socioeconomic factors. Future interventions should adopt a multi-level strategy, including strengthening regulatory measures in high-risk areas and opioid supply chains, expanding access to pharmacotherapy, and implementing comprehensive prevention strategies targeting socioeconomically disadvantaged populations. The findings provide essential evidence for optimizing public health resource allocation and formulating differentiated policies.