Objective  To analyze the disease burden and future trend of chronic hepatitis C (CHC) among individuals aged ≥50 years in China and worldwide from 1990 to 2021, and to provide scientific evidence for targeted prevention.

Methods  Data on CHC incidence and disability-adjusted life years (DALYs) were extracted from the Global Burden of Disease (GBD) 2021 study for China, the globe, and five sociodemographic index (SDI) regions. Age-standardized incidence rates (ASIR) and age-standardized DALY rates (ASDR) were calculated. The Joinpoint regression model was used to evaluate disease burden trends as average annual percentage change (AAPC). Subgroup analysis were stratified by sex and age. A decomposition model quantified the contributions of population growth, aging, and epidemiological changes. Bayesian age-period-cohort (BAPC) modeling was used to forecast disease burden trends for 2022–2040.

Results  In 2021, global and Chinese CHC incidence among individuals aged ≥50 years reached 1.244,4 million and 0.177,2 million, representing increases of 104.42% and 190.01% compared with 1990, respectively. During the same period, DALYs amounted to 6.738,6 million person-years globally and 0.335,2 million person-years in China, corresponding to a 46.14% increase worldwide and a 14.84% decrease in China. From 1990 to 2021, the global ASIR showed a significant declining trend [AAPC=-0.30%, 95%CI (-0.38%, -0.22%), P<0.001], whereas no statistically significant change was observed in China [AAPC=-0.02%, 95%CI (-0.26%, 0.30%), P=0.912]. Both global and Chinese ASDRs showed a declining trend [globally: AAPC=-1.28%, 95%CI (-1.41%, -1.15%), P<0.001; China: AAPC=-3.51%, 95%CI (-3.69%, -3.32%), P<0.001]. The global incidence peak occurred at 50-54 years, whereas in China it shifted to 65-69 years. DALY peaks were concentrated in the 50-59 age group. Decomposition analysis showed incidence growth was mainly driven by population expansion, accounting for 89.62% in China. Changes in DALYs exhibited regional variations, with China's decline in DALYs primarily attributable to epidemiological improvements (-822.78%). Projections suggest rising case numbers and DALYs globally and in China through 2040, despite overall downward trends in ASIR and ASDR.

Conclusions  CHC among individuals aged ≥50 years remains a significant public health challenge worldwide and in China. Although ADSR has decreased, the ageing population and delayed onset of CHC indicate that the disease burden remains at risk of increasing. Enhanced early screening, expanded antiviral coverage, and strengthened long-term management are urgently needed to mitigate the challenges of CHC in aging societies.

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