ObjectiveTo analyze the disease burden and evolving trends for gastric cancer in China and worldwide from 1990 to 2021. MethodsBased on the 2021 Global Burden of Disease (GBD) database, we analyzed the burden of gastric cancer using indicators such as incidence, mortality, disability-adjusted life years (DALYs), years of life lost (YLLs), and years lost due to disability (YLDs). Joinpoint regression analysis was used to calculate the average annual percentage change (AAPC) of these indicators to show trends over time. ResultsIn 2021, the standardized incidence rate of gastric cancer was 14.33 (per 100 000) worldwide and 29.05 (per 100 000) in China, with corresponding standardized mortality rates of 11.20 (per 100 000) and 21.51 (per 100 000). The standardized incidence rate of gastric cancer in China trended downward during 1990–2021 (AAPC=–1.61%, P<0.05), but was lower than the global decline (AAPC=–1.77%, P<0.05). During 1990-2021 in China, the rates of standardized DALYs (AAPC=–2.76%, P<0.05), standardized YLLs (AAPC=–2.78%, P<0.05) and standardized YLDs (AAPC= –1.25%, P<0.05) all showed a significant decrease. The global rates of standardized DALYs (AAPC=–2.42%, P<0.05), standardized YLLs (AAPC=–2.44%, P<0.05) and standardized YLDs (AAPC=–1.56%, P<0.05) all showed a significant decrease. These AAPC values above indicated a general attenuation in the gastric cancer burden across all age groups, both in China and worldwide. ConclusionsDespite these signs of a decline in disease burden indicators for gastric cancer in China and worldwide, the number of cases and deaths in gastric cancer remains substantial coupled with the heavy burden on the healthcare system. Therefore, increased efforts in early detection and prevention strategies are of utmost importance to further reduce the impact of this malignant disease.