Disability-free life expectancy (DFLE) is a vital measure of older adults’ quality of life. Although its temporal trends and determinants have been examined in previous studies, spatial heterogeneity has often been underestimated, because most analyses were conducted at aggregated national or provincial levels, masking local variations due to limited data availability.

Compared with 2018, DFLE increased in 2023, and the urban-rural gap narrowed overall, with slower improvement in the western region. The determinants of DFLE varied by region, age, and urban-rural context.

Public health strategies should be tailored to urban and rural contexts. Priority should be given to strengthening healthcare access, social security systems, and climate-adaptive infrastructure, particularly in rural areas of western China.

Mental health problems in older adults have become a major public health concern.

The prevalence of depression and anxiety symptoms in adults aged ≥60 years was 13.8% and 8.0%, respectively. Compared with good sleep quality, the odds ratio (95% confidence interval) of depression and anxiety for those with poor sleep quality was 7.88 (6.33, 9.79) and 6.42 (5.02, 8.22), respectively.

Early screening for depression and anxiety, lifestyle interventions and chronic disease management should be strengthened to promote mental health of older adults.

China’s aging population has a heavy chronic disease burden. Existing research often overlooks health heterogeneity among older age groups, relies on mortality metrics, and lacks information on long-term disability trends.

This study reveals that all-cause mortality declined substantially, whereas years lived with disability (YLDs) remained stable. Alzheimer’s disease and other dementias (ADOD) exhibited the fastest increase in mortality [average annual percent change (AAPC)=1.76, 95% confidence interval (CI): 1.63, 1.87]. Age-related hearing loss and falls dominated YLDs.

Public health strategies should shift from general approaches to age-tailored interventions. Integrating evidence-based stratified strategies is crucial for reducing disability and advancing Healthy China by 2030.

Musculoskeletal disorders, including gout, low back pain (LBP), osteoarthritis (OA), and rheumatoid arthritis (RA), impose a substantial global health burden that intensifies with population aging. China confronts distinctive challenges stemming from rapid demographic aging and evolving occupational patterns, yet comprehensive analysis using the latest Global Burden of Disease (GBD) 2023 data to inform long-term prevention strategies remains absent.

This study demonstrates that from 1990 to 2023, the disease burdens of gout, OA, and RA increased continuously, whereas the burden of LBP declined. Predictive modeling indicates these divergent trajectories — growth for gout, OA, and RA versus reduction for LBP — will persist through 2043. Additionally, substantial gender- and age-specific variations in disease burden were identified, with peak impacts concentrated in the 40–80 age range.

The rising burden of these musculoskeletal diseases, concentrated in the 40–80 age group, necessitates urgent interventions aligned with “Healthy China 2030” objectives. Key priorities must include managing modifiable risk factors (body mass index, occupational ergonomics), implementing targeted screening programs for high-risk populations (males for gout, females for osteoarthritis and rheumatoid arthritis), and optimizing hierarchical diagnosis and rehabilitation systems to mitigate long-term disability.