Multiple sclerosis burden and quality of care index in China and the G20 (1990–2021): A cross-regional analysis using global burden of disease database 2021

Multiple sclerosis (MS) is a chronic immune-mediated disease of the central nervous system with a growing global burden. While traditionally considered rare in Asia, China rising MS prevalence and disproportionate disability present major public health challenges. Comprehensive cross-regional comparisons between China, the group of 20 (G20), and global aggregates remain limited. Using data from the global burden of disease 2021 study, we quantified MS incidence, prevalence, mortality, and disability-adjusted life years (DALYs) in China, G20 countries, and worldwide from 1990 to 2021. Temporal trends were analyzed with joinpoint regression, drivers of burden were decomposed into epidemiological change, population aging, and population growth, and future trajectories were forecast to 2050 using autoregressive integrated moving average (ARIMA) models. To evaluate healthcare system performance, we further constructed a Quality of Care Index (QCI) based on composite ratios of incidence, prevalence, mortality, and DALYs. From 1990 to 2021, MS prevalence and DALYs increased substantially in all regions, with China exhibiting faster growth in DALYs than G20 or global averages, particularly among women and working-age adults. In contrast, the G20 showed a more pronounced aging of MS burden. Decomposition analysis revealed that population aging and epidemiological change were the primary drivers of China rising burden. Forecasting predicts continued growth of cases and DALYs through 2050. QCI analysis demonstrated global improvement in MS care quality, with China achieving marked progress, especially among elderly groups; however, persistent disparities remain, with lower QCI values in children, older adults, and women, showing a consistent “middle-high, both-ends-low” pattern across regions. The MS burden in China has expanded more rapidly than in the G20 or globally, with disproportionate impacts on women and working-age populations. Although care quality has improved, inequities by age and sex persist. These findings highlight the urgent need for earlier diagnosis, equitable access to disease-modifying treatments, and targeted interventions for vulnerable groups to mitigate the future burden of MS.