Objective To systematically analyze the mortality trend and epidemiological characteristics of Alzheimer's disease in elderly population in China from 1990 to 2021, and predict the mortality of Alzheimer's disease from 2022 to 2031.

Methods The data were from the Global Burden of Disease 2021 Database (GBD 2021). Joinpoint regression model was used to identify significant time points of mortality change, and annual percentage change (APC) was assessed for each time period to reveal the trend among different years. Meanwhile, age-period-cohort model was used to analyze the effects of age, time and cohort on mortality, and to explore the relative risk changes of each factor on mortality. Finally, the Nordpred model was used to predict the trend of Alzheimer's disease mortality from 2022 to 2031.

Results From 1990 to 2021, the mortality rate of Alzheimer's disease in the elderly population in China showed an increasing trend year by year, the total deaths increased from 109 829 cases in 1990 to 470 807 cases in 2021, and the crude mortality rate increased from 169.46/100 000 to 240.2/100 000. The mortality rate continued to be higher in women than in men, with crude mortality rate of 306.08/100 000 in women and 166.15/100 000 in men in 2021. Joinpoint regression model analysis showed that the mortality decreased from 1990 to 1999 and increased significantly from 2019 to 2021 (APC=1.97%, P<0.001), especially in men (t=2.490, P<0.05). The age-period-cohort model showed that age and period had significant effects on the mortality of Alzheimer's disease, but the relative risk was basically stable across different periods (relative risk 0.97−1.01), suggesting that despite the increase in the overall mortality, the relative risk showed no obvious change across different periods. The predictionc indicated that by 2031, the deaths from Alzheimer's disease in the elderly population would increase to about 747 300 cases, and the crude and standardized mortality rates would further increase.

Conclusion The results of this study suggested that the disease burden level of Alzheimer's disease in the elderly population in China would continue to increase in the future, especially in women and in the elderly, with significantly higher mortality compared with men and younger age groups. The overall mortality of Alzheimer’s disease was stable from 1990 to 2021, suggesting that current interventions are effective in the prevention of Alzheimer’s disease death, but targeted prevention strategies for groups at high-risk are still needed to be developed in the future.