To analyze the trends in the burden of cervical cancer attributable to smoking in China from 1990 to 2021, and to explore the disease burden patterns across regions with different Socio-demographic Index (SDI) levels, thereby providing a scientific basis for formulating targeted tobacco control measures and cervical cancer prevention strategies.

Based on data from the Global Burden of Disease (GBD) Study 2021, mortality and disability-adjusted life year(DALY) rates of cervical cancer attributable to smoking in China and five SDI regions among individuals aged 25-94 years were extracted. Joinpoint regression was used to analyze the temporal trends in age-standardized mortality rate (ASMR) and age-standardized DALY rate (ASDR). The Age-Period-Cohort (APC) model was employed to assess age, period, and cohort effects.

From 1990 to 2021, both the ASMR and ASDR of cervical cancer attributable to smoking in China decreased significantly, with average annual percentage changes (AAPCs) of -2.177% (95% CI: -2.592~-1.759) and -2.054% (95% CI:-2.280~-1.826), respectively. The overall burden in China remained consistently lower than the average of its corresponding SDI region. Regional comparisons revealed that the largest decline in mortality occurred in the middle SDI region (AAPC=-2.874%), while the fastest decline in ASDR was observed in the low SDI region (AAPC=-2.863%). The high SDI region showed the smallest declines for both metrics. In China, age-specific analyses showed that the most pronounced declines in ASMR for cervical cancer attributable to smoking were observed in the 70-74 and ≥95 years age groups. The ASDR exhibited a unimodal distribution with age, peaking at 57 years, and showed the largest decline in the 70-74 years age group. However, the disease burden in the 30-59 years age group still showed an increasing trend in some SDI regions. APC model analysis further indicated net drifts of -0.540% for ASMR and -1.946% for ASDR. Both period and cohort effects decreased significantly, with the cohort effect being the most prominent, showing an 82.97% reduction in the risk of DALY rates attributable to smoking from the 1895 to the 1990 birth cohorts.

From 1990 to 2021, the burden of cervical cancer attributable to smoking in China showed a significant overall decline, but with notable regional and age heterogeneities. Substantial improvements were observed in low and middle-high SDI regions and among older age groups, while the burden in young and middle-aged populations increased in some regions. Future prevention and control efforts should focus on the young and middle-aged population and promote tailored strategies across different regions.