Objective To systematically assess the spatio-temporal trends and driving factors of gastritis and duodenitis (GD) burden in China and globally from 1990 to 2021, providing evidence for optimizing global public health strategies.

Methods Using data from the Global Burden of Disease (GBD) 2021 study, we calculated age-standardized incidence rate (ASIR), age-standardized disability-adjusted life years rate (ASDR), and age-standardized mortality rate (ASMR) for GD in China and globally. Trends were evaluated using estimated annual percentage change (EAPC), and contributions from population growth, aging, and epidemiological changes were quantified through socio-demographic index (SDI) frontier analysis and Das Gupta decomposition.

Results  Globally, GD burden declined, with EAPCs of −0.42% (95%CI: −0.47% to −0.37%) for ASIR, −1.30% (95%CI: −1.35% to −1.24%) for ASDR, and −1.91% (95%CI: −1.98% to −1.84%) for ASMR. However, significant regional heterogeneity was observed: high-SDI countries (e.g., Germany, the UK) exhibited higher observed DALYs rates than predicted, while some low-income countries (e.g., Rwanda) exceeded expectations in improvement through policy interventions. China demonstrated significantly faster declines than the global average, with EAPCs for ASIR (−1.29%), ASDR (−2.44%), and ASMR (−2.83%) being 3.10, 1.90, and 1.50 times greater, respectively (all P<0.05). Gender stratification revealed that Chinese males experienced faster ASIR reductions (−1.52%) than females (−1.09%), yet females achieved greater mortality declines (females: EAPC = –3.22%, males: EAPC = –2.42%). Globally, female ASIR remained higher than male ASIR (367.92/100,000 vs. 277.33/100,000 in 2021). Age-specific analysis indicated a shift in disease burden toward older populations globally and in China. Crude incidence rates, DALYs rates, and mortality rates of GD declined across all age groups worldwide, yet the disease burden remained most pronounced among middle-aged and elderly populations. In China, the incidence peak shifted from the 55–<75 age group in 1990 to the 75–<95 age group in 2021, with a 62.10% reduction in DALYs rate among those aged ≥95 years. Decomposition analysis showed that global incident cases increased by 9 889 002, primarily driven by population growth (81.10%) and aging (64.15%), but offset by epidemiological improvements (e.g., Helicobacter pylori eradication, −45.26%). China has effectively mitigated the burden of population growth and aging by implementing robust preventive measures, achieving a contribution rate of -119.75% from epidemiological changes. Conclusion China has achieved remarkable success in controlling the disease burden of GD. However, the intensifying aging population has led to a shift in disease burden towards older age groups. Globally, high-SDI countries need to improve the efficiency of healthcare resource utilization, while low-SDI countries need to strengthen the resilience of their health systems. Moreover, incorporating age-specific and gender-differentiated strategies into core management approaches is essential.