Objective To analyze the overall and province specific incidence, mortality, and disease burden of brain and central nervous system cancer (brain cancer) in China from 1990 to 2021.

Methods Data from the Global Burden of Disease Study (GBD 2021) were used to analyze the incidence, mortality, and disability-adjusted life years (DALY) of brain cancer in China from 1990 to 2021. A log-linear regression model in software Joinpoint was used to calculate the average annual percentage change (AAPC) to describe the trends in brain cancer disease burden. Additionally, the change in mortality was decomposed to analyze the contributions of age-specific mortality, population aging, and population growth.

Results In 2021, the incidence rate of brain cancer in China was 7.42/100000 95% uncertainty interval (UI): 5.72～939, the mortality rate was 4.84/100 000 (95% UI: 3.66～6.20), and the DALY rate was 157.98/100 000 (95% UI: 120.60/～202.48). Compared with 1990, the incidence, mortality and DALYs of brain cancer in 2021 showed significant increases. The age-standardized incidence rate showed an increasing trend, while the age-standardized mortality rate and the age-standardized DALY rate decreased .The results by age group showed that incidence, mortality and DALY showed the first peaks at 5-<10 years of age, with an incidence rate of 3.50/100 000 (95% UI: 2.64-4.72) and a mortality rate of 1.33/100 000 (95% UI: 0.98-1.82), but they were at lower levels at the age of 10-<20 years. Both the incidence rate and mortality rate showed increasing trends with age, reaching 23.93/100 000 (95% UI: 16.73-29.67) and 21.23/100 000 (95% UI: 14.98-26.41) in age group ≥75 years. The incidence rate, mortality rate, and DALY rate in children under age of 5 years showed decreasing trends from 1990 to 2021, but the incidence rate in people over the age of 5 years showed an increasing trend, and the mortality rates in people aged 20-<35 years and ≥70 years showed increasing trends (all P <0.001). There were significant differences in the burden of disease of brain cancer among different provinces in China in 2021, with relatively high DALYs in Tianjin, Liaoning, and Heilongjiang. The overall brain cancer deaths increased by 75.97% in China from 1990 to 2021, with population ageing contributing to 64.36%, population growth contributing to 20.93% and age-specific mortality contributing to −9.33%.

Conclusion Over the past 30 years, the brain cancer mortality showed a slight decrease in China, but the incidence rate increased steadily. It is necessary to focus the population at high risk, such as children and the elderly, and explore appropriate screening and early intervention strategies to reduce the disease burden level.