Periodontal Disease Burden in China and G20 Nations: Insights From the Global Burden of Disease 2023 Study

Aims: This study aimed to compare the periodontal disease burden between China and G20 countries from 1990 to 2023, to identify temporal trends using joinpoint regression, to quantify the respective contributions of population growth, aging, and epidemiological changes through demographic decomposition analysis, and to forecast the future burden to 2033 using autoregressive integrated moving average (ARIMA) models. Methods: Leveraging the most recent Global Burden of Disease Study (GBD) 2023 data, we analysed incidence and disability-adjusted life years (DALY). Joinpoint regression characterized trends. Demographic decomposition analysis quantified contributions from population growth, aging, and epidemiological changes. Future burden was projected using ARIMA models. Results: The burden varied substantially across G20 nations. In 2023, China showed a moderately high burden with age-standardized incidence rate of 950.20 per 100,000 and DALY rate of 68.5 per 100,000, with marked male predominance (ratio ∼1.2:1) and peak in 45-59 years. Joinpoint analysis revealed an overall slight decline in China's incidence (AAPC = -0.13) but a notable increase during 2010-2014 (APC = 4.79). Decomposition analysis identified aging as the main driver of increased incident cases in China (contributing 67.12% of 7.65 million increase), whereas population growth dominated in G20 countries (+120.87% contribution). ARIMA projections suggest China's DALY rates may stabilize around 64-65 per 100,000 by 2033, while G20 rates remain persistently higher at approximately 78 per 100,000. Conclusion: Periodontal disease burden in China is primarily driven by population aging, while population growth is the main factor in G20 countries. Tailored public health strategies are essential for each context. Clinical relevance: From a public health perspective, these findings highlight need for targeted population-level strategies: In China, resource allocation should prioritize high-risk groups (e.g., middle-aged males and the elderly). In G20 countries, health planning should address persistent high DALY burden through integrated non-communicable disease prevention programs targeting shared risk factors.