Objective To describe the disease burden in the entire population in Hainan province and change characteristics from 1990 to 2021.

Methods Joinpoint regression model was used to calculate the annual percent change （APC） and average annual percent change （AAPC） of related indicators of disease burden. The changes of indicators of disease burden and the ranks of the top 10 causes of death in Hainan from 1990 to 2021 were analyzed.

Results Compared with 1990, the age−standardized rate of years of life lost due to premature mortality （ASYLLR）, age−standardized rate of life years lost due to disability （ASYLDR）, age−standardized rate of disability adjusted life year （ASDALYR） all decreased in Hainan in 2021, and the change levels were lower than the national levels. From 1990 to 2021, the AAPC of age−standardized mortality rate （ASMR） in the entire population in Hainan was −1.74% （t=−13.247, P<0.001）, showing a downward trend. The ASMR decreased from 1 438.75/100 000 to 877.32/100 000 in men, and from 950.71/100 000 to 507.16/100 000 in women. The rate of ASDALYR decreased from 47 570.67/100 000 to 26 773.83/100 000 in men and from 38 566.29/100 000 to 20 443.16/100 000 in women, showing downward trends. Compared with 1990, stroke was still the most important cause of death in Hainan in 2021, and the top 10 causes of death in 2021 newly included colon and rectal cancer and diabetes.

Conclusion Compared with 1990, cardio/cerebrovascular disease and cancer still caused heavy disease burden in the residents in Hainan in 2021. The ranks of lung cancer and dementia moved ahead obviously in the death causes. It is suggested to take early intervention measures according to the risk factors of the above diseases.