A global analysis of GBD 2021 data found that youth drinking contributed to 417,198 deaths across 194 WHO member countries and territories between 1990 and 2021, with deaths declining from 13,346 to 10,563 over the period. Boys and young men bore a far higher burden, and most alcohol-attributable deaths were linked to transport injuries, interpersonal violence, and self-harm, with marked disparities across SDI levels and countries.