BACKGROUND: Respiratory tract cancers emerged as a public health challenge with the highest incidence and mortality among all cancer types in China, despite many national policies in place, such as early cancer screening. It is of outmost importance to monitor the burden of respiratory tract cancers across China and its provinces for refining health strategies. METHODS: Based on Global Burden of Disease (GBD) estimates, the present study investigated the age-sex specific pattern alterations of incidence, prevalence, mortality, and disability adjusted life years (DALYs) of respiratory tract cancers in China from 1990 to 2021, as well as its Estimated Annual Percentage Change (EAPC), Age-Standardized Incidence Rate (ASIR), and Age-Standardized Mortality Rate (ASMR). FINDINGS: Between 1990 and 2021, China experienced an escalation in burdens of respiratory tract cancers, with the new cases surging from 274,752 (95% Uncertainty Interval (UI): 234,741-315,112) to 934,704 (750,040-1,136,938), marking an increase of 240.20% (156.05-342.29). Their attributed deaths similarly increased from 278,235 (238,518-322,013) to 814,121 (652,231-994,858). In 2021, the eastern and northeastern regions reported the highest incidence and mortality rates, particularly Shandong, with the highest new cases at 77,225 (58,842-101,352), while Tibet, Qinghai, and Macau observed the lowest. Regarding laryngeal cancer, Guangdong reported the highest incidence at 3466 (2230-4934), with Hainan exhibiting the highest ASIR at 3.46 (2.10-5.11) per 100,000 person-years and ASMR at 2.11 (1.37-3.09) per 100,000 person-years. Over the same timeframe, the EAPC for the ASIR of tracheal, bronchus, and lung cancer was 0.88 (0.63-1.14), and for ASMR, it was 0.29 (0.05-0.62), signifying an upward trend. Conversely, laryngeal cancer exhibited a stable ASIR with an EAPC of 0.04 (-0.22 to 0.30) and a declining ASMR with an EAPC of -1.69 (-1.80 to 1.59). Tracheal, bronchus, and lung cancer burdens exhibited notable sex differences, with their ASIR being 62.63 (46.50-79.90) per 100,000 person-years in males and 28.16 (22.22-34.90) per 100,000 person-years in females. For laryngeal cancer, the ASIR was 3.12 (2.34-4.04) per 100,000 person-years for males and 0.58 (0.35-0.79) per 100,000 person-years for females. Smoking and air pollution emerged as the predominant risk factors contributed to tracheal, bronchus, and lung cancer, accounting for 61.58% (30.00-82.95) and 25.98% (16.94-35.00) of deaths, respectively. In contrast, smoking contributed more to laryngeal cancer-caused deaths (76.70% [65.55-85.15]), followed by alcohol use (14.52% [7.70-20.99]). INTERPRETATION: The burden of respiratory tract cancers in China has increased over the past three decades, and without intervention, the associated health losses could escalate further. This burden predominantly affected the eastern provinces, particularly impacting older males. Our findings advocate for the formulation of targeted prevention, screening, and intervention strategies based on regional and sex disparities. FUNDING: Bill & Melinda Gates Foundation.