To analyze the changing trends of urolithiasis burden among Chinese young and middle-aged adults from 1990 to 2021 and predict disease burden from 2022 to 2030, providing evidence for public health strategies and healthcare resource allocation.

Utilizing the Global Burden of Disease 2021 database, we calculated incidence and disability-adjusted life years (DALYs) for urolithiasis in Chinese adults aged 20-54. Joinpoint regression identified temporal trends and turning points. Age-period-cohort modeling decomposed age, period, and cohort effects on incidence. Autoregressive integrated moving average (ARIMA) models projected future disease burden.

From 1990 to 2021, urolithiasis cases increased from 9.566 million to 10.197 million (EAPC=0.20%), while age-standardized incidence declined (EAPC= -0.39%). DALYs decreased from 58 700 to 42 200 person-years (EAPC= -1.06%), with DALY rate declining (EAPC= -1.67%). Males consistently exhibited higher standardized incidence and DALY rates. Age-period-cohort analysis showed a linear rise in incidence risk with age, with relative risks (RR) from 0.279 to 2.331. The period effect had a “rising-declining” fluctuation (RR 0.937-1.080). The cohort effect decreased steadily as birth year advanced, with RR values from 0.835 to 1.607. Projections suggest cases will reach 10.396 4 million by 2030, yet standardized incidence and DALY metrics will maintain downward trajectories.

Despite decreasing standardized disease burden and persistent gender disparities since 1990, urolithiasis demonstrates age-progressive risks, period-specific fluctuations, and cohort-driven mitigation. Predicted high absolute burden underscores the urgency for targeted prevention strategies to address this persistent public health challenge.