OBJECTIVES: The study aimed to investigate the disease burden of nasopharyngeal carcinoma (NPC) in Asia. MATERIAL AND METHODS: The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 data evaluated NPC metrics by sex, and age in Asia. Estimated annual percentage changes (EAPCs) were calculated to assess the trends of NPC burden. The decomposition analysis was used to analyze drivers of deaths and disability-adjusted life years (DALYs) of NPC. The DALYs of NPC attributed to modifiable risk factors were also assessed. And we predicted changes of NPC burden to 2044. RESULTS: In 2021, there were 101,841.49 (95 % UI: 88,093.77 to 118,402.42) incident cases, 62,079.09 (95 % UI: 54,879.91 to 70,240.60) deaths, and 2,041,239.04 (95 % UI: 1,796,551.45 to 2,315,547.51) DALYs due to NPC in Asia. From 1990 to 2021, age-standardized rates (ASR) showed a downward trend in Asia. East Asia bore the heaviest burden of NPC in the Asian region. China and India stood out as facing the most severe burdens. Central Asia was the only region in Asia where both ASIR and ASMR showed an upward trend, while ASR in Armenia experienced the fastest growth in Asian countries. The decomposition analysis showed that population growth was the main factor influencing NPC in Asia. Behavioral risks were the primary factors affecting NPC in Asia. CONCLUSION: NPC remains a significant public health issue in Asia, especially in East Asia. China and India still face challenges due to population aging and population growth. Armenia's rising incidence highlights urgent concerns. Strengthening prevention and treatment of NPC is crucial. CLINICAL SIGNIFICANCE: NPC continues to pose a significant public health challenge in Asia, especially in East Asia. The disease burden of Asian NPCs is increased by population growth. Targeted prevention and control policies of NPC must be implemented for high-risk areas, alongside efforts to reduce behavioral risk factors.