Burden and Temporal trends of Major Chronic Diseases among Adults aged over 60 in China from 1990 to 2021 and Projection to 2050

Background: Chronic diseases (CDs) pose a significant public health burden in China, particularly among adults aged ≥60 years. Rapid population aging has driven rising CD prevalence and mortality. This study comprehensively evaluates the burden and temporal trends of five major CDs—cardiovascular disease (CVD), neoplasms, neurological disorders, digestive diseases, and diabetes/kidney diseases—from 1990 to 2021, projecting outcomes to 2050. Methods: The study used data from the Global Burden of Disease (GBD) Study 2021, and analyzed age-standardized rates (ASRs) for incidence, prevalence, mortality, and disability-adjusted life years (DALYs). Advanced statistical approaches included the age-period-cohort model to disentangle temporal effects, Bayesian age-period-cohort projections, and decomposition analysis to quantify contributions of aging, population growth, and epidemiological changes. Results: In 2021, the age-standardized incidence rate of CDs was 26,401.62 per 100,000, with mortality declining significantly (AAPC: -0.97, P < 0.001). For overall CD, the growth of elderly population accounted for 96.76% of the 44.8 million additional incident cases, while aging contributed 3.84%. By 2050, absolute CD deaths are projected to surge by 511% despite declining age-standardized mortality rates. Gender disparities persisted: males faced higher mortality, while females exhibited elevated incidence. Cohort effects revealed generational improvements, with recent birth cohorts showing 85% lower mortality risks than earlier cohorts. Conclusion: While China’s healthcare advancements have reduced CD mortality, population aging will drive an inevitable rise in the absolute burden. However, with the growth of the aging population, the CD burden will still be a serious health concern in China.