Abstract / Summary
Abstract Background. Chronic kidney disease (CKD) is a leading cause of morbidity and mortality in China and worldwide. However, long-term projections of CKD integrating future epidemiological trends with healthcare costs and macroeconomic consequences are lacking. We projected the future health and economic burden of CKD across mainland China and its 31 provinces from 2025 to 2060. Methods. We conducted a modeling study integrating epidemiological projections, healthcare cost estimation, and macroeconomic modeling. Age- and sex-specific CKD incidence, prevalence, mortality, years lived with disability (YLDs), years of life lost (YLLs), and disability-adjusted life years (DALYs) were projected using Bayesian age–period–cohort models based on Global Burden of Disease 2023 data. CKD-attributable healthcare costs were estimated using nationally representative data from the China Health and Retirement Longitudinal Study and incorporated into a health-augmented macroeconomic model to estimate national and provincial gross domestic product (GDP) losses. Results. Age-standardized incidence and mortality rates are projected to remain relatively stable, while prevalence increases substantially. In contrast, age-standardized DALY rates are projected to decline, primarily driven by substantial reductions in YLLs despite increasing YLDs. The estimated cumulative per capita loss attributable to CKD during 2025–2060 was INT $5,594 (95% CI, INT $4,629–$6,393). The cumulative GDP loss attributable to CKD from 2025 to 2060 is projected to be INT $6.45 trillion (95% CI, INT $5.34–$7.37 trillion), equivalent to 0.40% (95% CI, 0.33%–0.46%) of total GDP during the same period. Substantial geographic heterogeneity was observed, with the largest GDP losses attributable to CKD in provinces of Hebei, Guangdong, and Henan, while the highest per capita GDP losses were projected in provinces of Qinghai, Hebei, and Jiangxi. Conclusions. CKD is projected to impose a rapidly growing clinical and economic burden across China over the next three decades. The substantial regional heterogeneity identified in this study highlights the need for province-specific strategies to strengthen CKD screening, early detection, long-term disease management, and healthcare resource planning. These findings provide evidence to support more effective allocation of kidney care resources and inform national strategies to mitigate the future burden of CKD.