To analyze the burden and trends of acute lymphoblastic leukemia (ALL) in China from 1990 to 2021,providing reference for prevention and treatment strategies.

Data on incidence, prevalence, mortality, and disability-adjusted life years (DALY) for ALL in China were extracted from the Global Burden of Disease Study database (GBD 2021). The Join point regression model was utilized to fit the trends over the years, identify significant inflection points, and calculate the average annual percentage of change (AAPC) from 1990 to 2021 to reflect changes in disease burden. The distribution and trends of ALL across different time periods, genders, and age groups in China were analyzed.

In 2021, the age-standardized incidence rate (ASIR), age-standardized prevalence rate (ASPR), age-standardized death rate (ASDR), and standardized DALY rate for ALL in China were 3.64 per 100 000, 22.02 per 100 000, 1.36 per 100 000, and 74.06 per 100 000, respectively, with a higher burden in males than females. The ASIR and ASPR showed an upward trend, while the ASDR and DALY rates significantly decreased, with the gender disparity in disease burden becoming increasingly pronounced. After 2019, the incidence and prevalence rates in the 2-4 age group declined significantly, with the highest incidence, prevalence, and DALY rates observed in those under 1 year of age by 2021, while the highest mortality rate shifted from infants to the elderly.

The overall burden of ALL in China from 1990 to 2021 shows a downward trend, particularly notable in children, while the burden in adults has increased. There is a need to strengthen preventive measures for ALL among males and children while enhancing effective management of the high mortality rates in the elderly population.