Edentulism in China and the Group of Twenty (G20): Epidemiological Trends, Decomposition Analysis, and Forecasts to 2038

AIMS: Edentulism is a severe global oral health burden, particularly in aging societies. While previous studies have documented epidemiological trends, a direct comparison of the drivers and future trajectories between a rapidly aging economy like China and the broader Group of Twenty (G20) nations are lacking. This study aimed to compare temporal trends, decompose contributing factors, and forecast the future burden of edentulism in China versus the G20 aggregate from 1990 to 2038. METHODS: Using Global Burden of Disease 2023 data, we analysed age-standardised incidence rates (ASIR) and disability-adjusted life years (DALYs) for edentulism. We employed Joinpoint regression to assess temporal trends (1990-2023), and demographic decomposition analysis to quantify contributions from population growth, aging, and epidemiological change, and Autoregressive Integrated Moving Average models to forecast burden through 2038. RESULTS: From 1990 to 2023, China's ASIR declined modestly by 5.9% and DALYs by 11.0%, lagging behind reductions achieved by top-performing G20 nations. Decomposition analysis revealed a fundamental divergence in drivers: population aging accounted for over 80% of the net increase in China's burden, whereas population growth was the predominant contributor (78.7%) for the G20 overall. ARIMA forecasts indicate that China's burden will experience a brief decline followed by a sustained rebound, stabilizing at a level higher than the G20 average. CONCLUSION: China's edentulism burden is predominantly driven by population aging, contrasting with the G20's reliance on population growth as the primary driver. Future trajectories suggest China will face greater long-term oral health pressures than the G20 average. CLINICAL RELEVANCE: Oral health strategies in China must pivot from generic prevention toward age-specific interventions. Integrating comprehensive oral healthcare into geriatric medicine and national chronic disease frameworks is imperative to mitigate the escalating burden driven by an unprecedented aging population.