Objective To analyze trends in the disease burden of tracheal, bronchial, and lung cancer (TBL) in China and in low, medium, and high socio-demographic index (SDI) countries and regions from 1990 to 2021, with the aim of providing a basis for developing targeted prevention and control strategies. Methods Using the Global Burden of Disease (GBD) 2021 database, we extracted TBL-related data for different genders, age groups, and years from 1990 to 2021. The dominant factors contributing to the disease burden and the relationship between DALYs and SDI were analyzed. Results In 2021, China's overall TBL burden was significantly higher than other groups, with substantially greater increases in the number of cases, deaths, and DALYs compared to other groups. The growth rates of ASPR, ASMR, and ASDR also exceeded the overall levels of other SDI countries.The ASPR for all grouped TBLs showed an overall trend of increasing followed by decreasing with age. However, the ASPR for Chinese and middle-SDI male groups exhibited a downward trend in the age range 80-84 years old. Decomposition analysis revealed that the dominant factors for the increase in disease burden of TBL in each group are different. The growth DALYs in China and middle-SDI countries were primarily driven by population aging, while low-SDI countries were mainly influenced by population growth and high-SDI countries were predominantly affected by epidemiological changes. Global health inequalities in TBL have improved, yet low-SDI countries continue to bear a disproportionately heavy health burden. Conclusion The burden of TBL disease in China has steadily increased from 1990 to 2021, currently ranking among the highest globally. Multiple factors, primarily driven by population aging, continue to exacerbate China's TBL burden. The TBL disease burden is influenced by aging, gender differences, and SDI levels. China and low- middle SDI countries should implement targeted intervention strategies based on epidemiological research, including expanding public health service investments and strengthening healthcare system development, to alleviate the increasingly heavy TBL burden.