Objective To analyze the current status and temporal trends of the disease burden of osteoarthritis (OA) in China from 1990 to 2023, stratified by anatomical sites (knee, hip, hand, and other), utilizing data from the 2023 Global Burden of Disease (GBD) study, and to explore the site-specific heterogeneity of disease burden attributed to high body mass index (BMI), providing a scientific basis for formulating precision prevention and control strategies.Methods Based on the GBD 2023 database, data on the incidence, prevalence, and years lived with disability (YLDs), as well as their corresponding age-standardized rates of OA in China from 1990 to 2023, were collected and stratified by gender, age, and anatomical site (knee, hip, hand, and other). A log-linear regression model was employed to calculate the estimated annual percentage change (EAPC) to analyze temporal trends. Additionally, the population attributable fraction (PAF) was used to quantify the contribution of high BMI to OA across different sites and to analyze the heterogeneity of this attribution. Results In 2023, the disease burden of OA in China increased. In terms of anatomical distribution, knee OA constituted the heaviest burden, with 115.0032 million prevalent cases, accounting for approximately 65.78% of the total. Attribution analysis showed that knee OA was slightly more affected by high BMI than hip OA, and the PAF increased significantly over time. In 2023, the PAFs for knee and hip OA in females (29.49% and 28.57%, respectively) were substantially higher than those in 1990 (19.10% and 18.38%). A similar upward trend was observed in males (26.65% and 25.92% in 2023). Regarding attribution differences, female PAF levels were consistently higher than those of males across all years and sites. Hand OA exhibited the fastest growth rate, with the EAPC of its age-standardized YLDs rate reaching 1.64%, far exceeding that of knee OA (0.43%). Demographically, all burden indicators were higher in females than in males. Hand OA demonstrated an intergenerational cumulative effect. The difference in YLDs rates between 2023 and 1990 widened with age, reaching 123.29 per 100 000 in the >95 years old group, highlighting the severe challenges posed by population aging. Conclusion From 1990 to 2023, the disease burden of OA in China continued to rise. Knee OA remains the heaviest burden category and is significantly driven by high BMI, whereas hand OA shows the fastest growth trend. Prevention and control strategies should focus on weight management for knee and hip OA, while prioritizing the prevention and care of hand OA in the elderly population.
