To analyze the changing trends of CRD disease burden in China’s elderly population from 1990 to 2021, and to provide a reference for the development and adjustment of chronic disease prevention and treatment strategies for the elderly in China.

Based on the Global Burden of Disease (GBD) 2021 database on the burden of disease of CRD in China between 1990 and 2021, we described the burden of disease of CRD in China by gender and age groups, and used Joinpoint regression to analyse the temporal trends of age-standardised incidence rate (ASIR) of CRD, age-standardised mortality rate (ASMR) and age-standardised disability-adjusted life years (DALYs) rate (ASDR). The age, period and cohort effects of CRD incidence and mortality in the elderly in China were estimated using the Age-Period-Cohort (APC) model.

Compared with 1990, there was an overall fluctuating downward trend in the number of CRD incidence, death, and DALY in China in 2021, and a decreasing trend in the ASIR, ASMR, and ASDR, with the annual average percentage change (AAPC) of -1.05%, -3.68%, and -3.56%, respectively P < 0.001, and the ASIR, ASMR and ASDR were higher in males than in females. The results of the incidence rate APC model showed that, for the age effect, the relative risk (RR) values of the risk of CRD incidence in elderly Chinese men ranged from 0.448 to 1.872, and the RR values of the risk of CRD incidence in elderly women ranged from 0.438 to 1.679; for the period effect, the RR values of the risk of CRD incidence for men in all periods ranged from 0.960 to 1.051, and the RR values of the risk of CRD incidence for women ranged from 0.921 to 1.139; for the cohort effect, the RR values of morbidity risk ranged from 0.687 to 1.221 for men and from 0.714 to 1.345 for women. The results of the mortality APC model showed that, for the age effect, the RR values of mortality risk of CRD in elderly Chinese men ranged from 0.134 to 5.053, and in elderly Chinese women, the RR values ranged from 0.130 to 5.090; for the period effect, the RR values of mortality risk for males in each period ranged from 0.826 to 1.221, and the RR values of morbidity risk for females ranged from 0.697 to 1.479; for the cohort effect, the RR values of mortality risk for males ranged from 0.374 to 1.693, and those for females ranged from 0.374 to 1.724, and the results of the APC model test showed a statistically significant difference (P < 0.05). The differences were statistically different (P < 0.001).

The burden of CRD disease in China from 1990 to 2021 showed a decreasing trend, and the burden was significantly heavier in men than in women. The risk of CRD incidence and mortality in the elderly increased with age, decreased over time, and decreased with the development of birth cohorts. In the future, the focus should be on men and the elderly population, and active measures should be taken to address them.