Sex-specific trends in incidence and mortality of interstitial lung disease and pulmonary sarcoidosis in China compared with global estimates, 1990-2023: an analysis of GBD 2023.

Background: Interstitial lung disease and pulmonary sarcoidosis (ILD/PS) constitute a heterogeneous group of diffuse parenchymal disorders with rising public health importance amid global ageing, air pollution, and post-coronavirus disease 2019 (COVID-19) respiratory sequelae. China, with the world's largest ageing population and a complex environmental exposure profile, faces particular challenges, yet up-to-date comparisons against international trends remain scarce. Using newly released Global Burden of Disease (GBD) 2023 estimates, we reassessed long-term trends in ILD/PS burden in China and globally from 1990 to 2023, with a focus on sex differences and the unexpected fluctuation in 2023. Methods: Annual age-standardized incidence rate (ASIR), age-standardized death rate (ASDR), and age-standardized disability-adjusted life year rate (ASDALY) per 100,000 population, together with absolute counts, were extracted from the Institute for Health Metrics and Evaluation (IHME) GBD Results Tool for the cause "interstitial lung disease and pulmonary sarcoidosis" (Cause ID 516), stratified by sex. GBD estimates draw on vital registration, China's Disease Surveillance Points (DSP) system, censuses, and published studies, with standardized garbage-code redistribution. Long-term trends were quantified using estimated annual percentage change (EAPC) from log-linear regression. Turning points in China's ASDR were assessed using segmented (joinpoint-like) regression. Mortality-to-incidence ratio (MIR) and endpoint sensitivity analyses (ending in 2021, 2022, and 2023) were used to evaluate the robustness of the 2023 fluctuation. Results: In 2023, global ASIR and ASDR were 4.75 and 2.40 per 100,000, whereas China had lower ASIR (2.12 per 100,000) and ASDR (0.46 per 100,000). China's ASDR increased from 0.18 to 0.46 per 100,000 during 1990-2023 [EAPC 3.55%, 95% confidence interval (CI) 3.27-3.82], exceeding the global increase (EAPC 1.96%, 95% CI: 1.81-2.11%). Although males generally had higher incidence and mortality rates, the fastest rise in mortality occurred among females in China (ASDR EAPC 5.18%, 95% CI: 4.84-5.51%), markedly higher than Chinese males (2.60%, 95% CI: 2.37-2.84%) and global females (2.05%, 95% CI: 1.90-2.20%). A turning point was suggested around 2011, with slower but persistent increases thereafter. China's MIR rose from 0.09 (1990) to 0.22 (2023), with an anomalous increase in 2023, coinciding with a decline in ASIR. Conclusions: ILD/PS burden in China has risen steadily over three decades, with mortality increasing faster than the global average and a particularly rapid rise among females. To address these disparities, China may consider expanding access to high-resolution computed tomography (HRCT) and multidisciplinary diagnostic teams in primary and secondary care, implementing sex- and age-targeted case-finding programmes for older women with cumulative biomass and ambient air pollution exposure, sustaining ambient air-quality improvements, and strengthening post-COVID-19 respiratory surveillance through linkage with clinical registries.