Anxiety disorders in China and G20 countries: A comparative burden study

ObjectiveTo compare the burden and temporal patterns of anxiety disorders in China with those in Group of Twenty (G20) countries from 1990 to 2021 and to project future disease burden.MethodsThis ecological secondary analysis used publicly available, aggregated estimates from the Global Burden of Disease Study 2021 for China and G20 countries. We assessed incidence, prevalence, and disability-adjusted life years using decomposition analysis, autoregressive integrated moving average models, and Bayesian age-period-cohort models.ResultsChina's age-standardized anxiety disorder burden decreased after 2000 (average annual percentage change, -1.2%). Its age profile differed from those of G20 countries, with a relatively greater disease burden among middle-aged and older adults. The prevalence of anxiety was 1.8-fold higher in females than in males. Decomposition analysis attributed 68% of the increase in anxiety prevalence in China to epidemiological change and population growth, whereas population aging accounted for 52% of the increase in G20 countries with a high sociodemographic index. The total number of anxiety cases in China were projected to rise by 22% by 2040, despite stable age-standardized rates.ConclusionsAnxiety disorder burden patterns differed between China and G20 countries and were associated with demographic and developmental contexts. These ecological findings support development-sensitive mental health planning and warrant confirmation in studies using individual-level data.