Abstract: Objective To analyze the long-term trends and future projections of the burden of age-related hearing loss(ARHL)in China between 1990 and 2021, with comparisons to global data. Methods Using publicly available data from the Global Burden of Disease Study 2021, we estimated the burden of ARHL in China based on prevalence and disability-adjusted life-years(DALYs)and their age-standardized rates. Estimated annual percentage change(EAPC)was used to assess trends from 1990 to 2021, while autoregressive integrated moving average models were used to predict prevalence and DALYs for China and globally from 2022 to 2050. Results Between 1990 and 2021, the number of ARHL cases in China increased by 124.7%(from 198 million to 445 million), surpassing the global increase of 108.6% with 1.546 billion cases worldwide during the some period. The age-standardized DALYs rate(ASDR)increased from 557.47 to 630.67 per 100,000 person-years(EAPC=0.35), exceeding the global trend(EAPC=0.16). Significant gender differences were observed, with males exhibiting higher ASDR(667.54 vs. 592.27 per 100,000)and faster growth(EAPC: 0.35 vs. 0.17). Age-specific analysis revealed the highest number of cases in the 55-59 age group(65.80 million), with prevalence exceeding 70% in individuals aged ≥70 years. In particularly, the <20 age group showed the fastest growth in prevalence(EAPC=0.81). Projections indicate that China will have 662 million ARHL cases by 2050, with a 71.3% increase in DALYs, significantly higher than the global increase of 11.3%. Conclusion China is experiencing a rapidly growing ARHL burden with unique characteristics that require targeted interventions focusing on hearing care for older adults and noise protection for younger populations.

Key words: Age-related hearing loss, Disability adjusted life-years, Estimated annual percentage change, Aging, Hearing health