Long-term trends in the burden of nasopharyngeal carcinoma in China: A comprehensive analysis from 1990 to 2021 and projections to 2030 based on the global burden of disease study 2021

•NPC burden in China shows gender disparities, with higher rates in males.•Incidence rates of NPC declined overall but surged post-2006, especially in males.•Prevalence continues to rise, with significant impacts on middle-aged males.•Aging and population growth contribute majorly to NPC burden.•Projections indicate increasing NPC cases, highlighting need for targeted interventions. Nasopharyngeal carcinoma (NPC) is a significant public health issue in China, with distinctive epidemiological characteristics and evolving trends. This study aims to analyze long-term trends in NPC burden from 1990 to 2021 and provide projections. Data from the Global Burden of Disease (GBD) database (1990–2021) was utilized to evaluate NPC metrics, including incidence, prevalence, mortality, and disability-adjusted life years (DALYs). Joinpoint regression identified significant changes over time. Age-period-cohort (APC) analyses assessed the effects of age, period, and cohort. A decomposition analysis identified factors influencing changes in NPC incidence, prevalence, and DALYs. Projections were made for future trends up to 2030. In 2021, NPC significantly impacted China, with males experiencing higher incidence (5.16 per 100,000) and mortality rates (2.32 per 100,000) than females. NPC prevalence was 342,477 cases, with males accounting for 260,164. DALYs totaled 982,657, predominantly affecting males. From 1990 to 2021, the age-standardized incidence rate (ASIR) in China decreased from 4.64 to 3.42 per 100,000, while globally it declined from 1.74 to 1.38 per 100,000. Between 1990 and 2021, trends showed an initial decline in ASIR and age-standardized prevalence rate (ASPR), followed by a steady increase from 2006 onwards, with males experiencing more significant rises. Mortality rates showed a general downward trend, yet males remained disproportionately affected. Comparative global data indicated that while NPC metrics are declining worldwide, the burden remains higher in China. Decomposition analysis highlighted aging and population growth as major contributors to the NPC burden. Bayesian age-period-cohort (BAPC) projections indicated a continuing rise in age-standardized incidence and prevalence rates for both males and females up to 2030. The burden of NPC in China remains significant, particularly among the male population. Despite declining mortality rates, the increasing prevalence suggests that more people are living with NPC. Targeted public health interventions