Abstract
BACKGROUND: Gender differences have a significant impact on disease burden. Although there is extensive research on disease burden in China, the age-related and long-term trends in gender differences for major diseases are not clear. This study analyzes the gender differences in the burden of 20 major diseases in China from 1990 to 2021, revealing temporal and age-related trends, and providing evidence for gender-sensitive public health policies. METHODS: This study uses data from the Global Burden of Disease Study 2021 (GBD 2021) to analyze gender differences in 20 major diseases in China. Absolute differences (male DALY − female DALY) and relative differences (absolute difference / male DALY × 100%) were calculated to analyze the long-term trends and age-related characteristics of gender differences across different age groups (0–14 years, 15–49 years, 50–69 years, 70 + years). RESULTS: In 2021, diseases with a significantly higher burden for males included stroke (male 31,862,593.3 vs. female 21,328,097.8; absolute difference 10,534,495.5, relative difference 33.1%), cirrhosis and other chronic liver diseases (relative difference 69.3%), and lung cancer (absolute difference 6,743,543.2). Alzheimer’s disease and other dementias were the only diseases with a higher burden in females (female 6,500,198.7 vs. male 3,572,278.8; relative difference − 82%). Gender differences were present in early childhood, especially in neonatal disorders and road injuries, while stroke showed the largest gender difference in the elderly. Between 1990 and 2021, the gender difference in diabetes mellitus declined (from 8.1% lower in males to 10.3% higher in males). The gender gap continued to widen for cirrhosis (relative difference increased from 55.1 to 69.3%) and ischemic heart disease (from 19.7 to 34.3%). CONCLUSION: Over the past 30 years, gender differences in disease burden in China have changed dynamically, influenced by biological, behavioral, and sociocultural factors. Public health policies should focus on high-risk behaviors in males, such as smoking, drinking, and occupational exposure, by implementing cardiovascular disease and cancer screening programs. For elderly females, a community care network for dementia and early intervention for postmenopausal metabolic diseases should be established. Optimizing healthcare resource allocation and promoting targeted interventions can reduce gender health inequalities. CLINICAL TRIAL NUMBER: Not applicable. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12889-025-23354-3.