Global Burden of Alcoholic Cardiomyopathy in Adults Aged 60 and Older From 1990 to 2021: A Secondary Analysis of Global Burden of Disease 2021 Data

Background: Alcoholic cardiomyopathy (ACM) poses a significant global health challenge, yet its impact on elderly populations across regions remains underexplored. Methods: Using Global Burden of Disease (GBD) 2021 data sourced from the official visualization platform, we analyzed ACM burden among individuals aged ≥ 60 years across 204 countries (1990-2021). Age-standardized rates (ASR) for prevalence, mortality, and disability-adjusted life years (DALYs) were calculated. Trends were assessed via estimated annual percentage change and Joinpoint regression. Future burden (2022-2050) was projected using Bayesian age-period-cohort models. Inequalities were measured using Slope and Concentration Indices, while frontier analysis identified optimization potential. Results: In 2021, global age-standardized prevalence, mortality, and DALY rates were 19.33, 2.64, and 58.55 per 100,000, respectively, declining since 1990. Eastern Europe exhibited the highest burden (ASDR: 645.87), notably in Hungary, Russia, and Latvia. Males experienced 3-5 times higher rates than females. While Southern Latin America saw substantial declines, the Caribbean observed increases. A positive correlation existed between the Socio-demographic Index (SDI) and ASRs. Decomposition analysis indicated population growth drove prevalence increases, whereas epidemiological improvements reduced mortality. Projections suggest a slight prevalence rise by 2050. Alcohol consumption remained the primary risk factor, especially in high-SDI regions. Conclusion: Although age-standardized ACM burden decreased among the elderly from 1990 to 2021, absolute numbers rose due to population aging and growth. Targeted interventions are needed, particularly in high-burden regions and among males.