Priorities in tackling noncommunicable diseases among the population aged 60 years and older in China, 1990-2021: A population-based study

Objective: In China, it is expected that every one in three people will be aged 60 years and above in 2040, surpassing other low- and middle-income countries. The noncommunicable disease (NCD) burden and trends among elderly people must be clarified. Methods: In this trend analysis based on the Global Burden of Diseases Study 2021, we reported NCDs per 100,000 people and average annual percentage changes (AAPCs) in disability-adjusted life-years (DALYs), mortality, and incidence at three levels of the GBD 2021 hierarchy by age subgroups and by sex in the older population aged 60 years and above in China during 1990-2021. Results: In 2021, there were 382 million incident cases of NCDs among elderly individuals in China, leading to 201 million DALYs and 9 million deaths in the same year. During 1990-2021, although cardiovascular diseases substantially reduced both DALYs (-1.2 %/year) and mortality (-1.08 %/year), cardiovascular diseases still accounted for the greatest percentage of DALYs (31000 per 100,000 population [95% UI 26071-35908]) and mortality (2025 [1678-2355]) in 2021. During 1990-2021, while the total incidence of NCDs decreased (-0.01 %/year), the incidence of mental disorders (0.68 %/year) rapidly increased. Among all level 3 causes, depressive disorder caused the greatest increases in DALYs (0.74%/year), while chronic respiratory diseases showed the most rapid decreases in both DALYs (-3.6 %/year) and mortality (-3.6 %/year). The priorities of NCD control in each age subgroup and sex among elderly individuals varied. In 2021, males had a greater DALY rate from NCDs per 100,000 people than females did (96409 [95% UI 80625-112283] vs. 67112 [56878-77547]), but females had a greater incidence rate of NCDs than males did (150276 [139285-163373]) vs. 137571 [127439-148789]). High systolic blood pressure had surpassed household air pollution from solid fuels as the leading risk factor for DALYs among the elderly, and it continued to be the top risk factor for mortality in this population. Conclusions: The total NCD burden among elderly people in China has been decreasing and changing. Substantial reductions in cardiovascular diseases and chronic respiratory disease have been observed, while rapid increases in mental disorders has also been found. Policies need to be updated to reflect the changing risk landscape. Target interventions should consider age subgroups and sex differences among this population.