Burden of osteoarthritis in China and Asia from 1990 to 2021 and projections to 2050: A systematic analysis for the Global Burden of Disease Study 2021

PURPOSE: As a common chronic joint disease, osteoarthritis (OA) represents a significant public health challenge. Analysing its burden is important for its prevention, treatment and policy development. METHODS: Incidence, prevalence and disability-adjusted life years (DALYs) data for China and Asia from 1990 to 2021 were obtained from Global Burden of Disease (GBD) 2021. Trends were analysed through the Joinpoint regression and age-period-cohort (APC) model. Decomposition analysis quantified contributions from aging, population growth and epidemiological change. The autoregressive integrated moving average (ARIMA) model forecasted disease trends. RESULTS: From 1990 to 2021, the number and age-standardized rates (ASRs) of incidence (ASIR), prevalence (ASPR) and DALYs (ASDR) all increased significantly. Knee OA was the predominant subtype, with a particularly pronounced burden in China, whereas hand and hip OA exhibited higher ASRs across Asia. OA had age and gender disparities, with higher risks at ages 50-59 and among females. Joinpoint regression revealed faster annual growth in China (ASIR: 0.4292; ASPR: 0.4391; ASDR: 0.4911) than in Asia (0.3596, 0.4097, 0.4529). The APC model indicated a slightly earlier peak incidence age group in China, suggesting a possible shift in RR toward younger age groups. Period effects showed that risk increases over time, with the later birth cohort at higher risk. Decomposition analysis indicated that population aging is China's primary driver, while population growth is more crucial in Asia. Projections to 2050 indicate that, while ASRs may stabilize, the absolute burden will remain substantial, with a notably rising trend projected for males relative to females. CONCLUSION: OA poses a substantial burden in both China and Asia, requiring differentiated prevention and control strategies tailored to regional characteristics. China should focus on addressing the dual challenges of population aging and obesity, while Asia as a whole needs to address population growth and enhance healthcare accessibility and diagnostic-therapeutic capacity. LEVEL OF EVIDENCE: N/A.