Abstract
Background: China has the largest population with Alzheimer's disease and related dementias (ADRDs) globally, and rapid population aging is expected to drive a substantial increase in cases. This study projects ADRD prevalence and associated economic burdens across provinces in China from 2025 to 2060. Methods: Using data from the China Health and Retirement Longitudinal Study (CHARLS) supplemented by national demographic and provincial statistics, we projected the prevalence and care costs of ADRD for each of the 31 provinces in China from 2025 to 2060. Cost projections included formal care expenses and informal caregiving valued through replacement cost methods. We conducted uncertainty analysis to provide robust estimates for ADRD prevalence and costs. Results: By 2060, ADRD cases in China are projected to reach approximately 49.89 million, with the highest prevalence and economic burden concentrated in provinces such as Shandong, Sichuan, Jiangsu, Henan, and Guangdong. Formal care costs alone are expected to exceed $1 trillion annually, while the total economic value-including informal caregiving-could surpass $5 trillion. Geographic disparities highlight that Eastern and Central regions, with a higher proportions of older adults, will bear disproportionate costs. Informal caregiving is projected to constitute 60% to 80% of total ADRD-related costs. Conclusion: China faces an unprecedented rise in ADRD-related economic burden over the next 4 decades, with substantial regional disparities. Strengthening long-term care infrastructure, expanding financial and social support for caregivers, and implementing regionally tailored healthy aging policies are essential to ensuring equitable and sustainable ADRD care across China.