Gender and age disparities in risk factor burden in China: a GBD 2021 analysis with projections to 2050

Objective To identify gender- and age-specific risk factors in China, informing targeted prevention strategies. Methods Using GBD 2021 data, we analyzed exposure, mortality, and disability burdens for 68 risk factors across genders/age groups. Estimated Annual Percentage Change (EAPC) quantified 32-year trends (1990–2021). Future trends (2022–2050) were projected via ARIMA modeling. Results Ambient particulate matter pollution exposure increased most markedly (Female EAPC: 5.26%; Male: 4.50%), with SEV projected to exceed 88% across all ages by 2050. Associated deaths and YLDs will concentrate in those ≥ 70. Mortality from nutritional deficiencies declined significantly (e.g., vitamin A deficiency: Female EAPC − 17.37%; Male − 18.02%). Notable gender disparities existed in 2021: insufficient milk intake (Women: 97.97% SEV; Men: 51.76%) and secondhand smoke (Women: 72.82% SEV; Men: 33.34% vs. 43.38% smoking rate). Diets high in red meat (EAPC: 18.92%), sugar-sweetened beverages (EAPC: 4.18%), and processed meat increased mortality risk, exacerbating metabolic factors (BMI, FBG, LDL, SBP) in ages 15+, elevating future death/disability burdens. For children (5–14 years), nutrition (vitamin A deficiency, short gestation, low birth weight) and metabolic (high BMI) factors are projected to increase disability burden. Conclusion Risk factor profiles distinctly vary by gender and age in China, necessitating demographically tailored prevention for effective disease control and public health improvement.