Alcohol-related injury burden in youth and alcohol policies in the Nordic countries, 1990–2023

Aims

Adolescents and young adults experience a disproportional burden from alcohol use, with injuries as the leading contributor. This study quantified injury burden attributable to high alcohol use among individuals aged 15-29 in Denmark, Iceland, Finland, Norway and Sweden from 1990 to 2023, and examined its association with alcohol policy restrictiveness.

Methods

Alcohol-attributable injury burden was measured using disability-adjusted life years (DALYs), years of life lost (YLLs), years lived with disability (YLDs) and deaths per 100,000 population from the 2023 Global Burden of Disease Study. Alcohol control policies were scored annually across six domains: production, distribution, legal age limits, marketing, blood alcohol limits, public policy and taxation. Spearman correlations and panel regression models examined associations between policy restrictiveness and injury outcomes.

Results

Injuries accounted for 26–38% of alcohol-attributable burden, with unintentional injuries contributing most (13–18%). Men consistently had higher injury DALYs than women, with the gender gap narrowing over time, with largest in Finland (6.4 to 4.1 times higher) and smallest in Denmark (4.6 to 3.2). Overall injury burden declined substantially, driven by reductions in road injuries, self-harm and premature mortality, while YLDs remained stable and accounted for ∼50% of total injury burden by 2023. Higher policy restrictiveness was associated with lower unintentional injuries, while associations with other causes were heterogeneous.

Conclusions

Despite substantial decreases since 1990s, alcohol-attributable injury burden remains high among Nordic youth aged 15–29 years. Stricter alcohol policies were linked to lower unintentional injury burden, e.g., falls, whereas effects on transport injuries, self-harm and interpersonal violence varied across countries and estimates, highlighting the need for more targeted policies, particularly addressing alcohol use among young men.

Key messages

• Alcohol-attributable injury burden remains substantial among Nordic youth, even with declines in alcohol-related harm, particularly in premature mortality from road injuries and self-harm.

• Stricter policies were linked to lower unintentional injury burden, but effects on other injuries were mixed, highlighting the need for age- and sex-specific measures, especially targeting young men.