BACKGROUND: Foreign body aspiration (FBA) is a preventable yet underrecognized global health challenge, contributing to substantial clinical and economic burdens. Comprehensive and comparable analyses of FBA trends across diverse populations and socioeconomic contexts remain limited. Leveraging data from the 2021 Global Burden of Disease (GBD) Study, we provide an in-depth global, regional, and national analysis of FBA trends over the past three decades, including the first evaluation of disability-adjusted life years (DALYs), years of life lost (YLLs), and years lived with disability (YLDs). METHODS: We examined FBA incidence, mortality, and disease burden across regions, nations, ages, sexes, and Socio Demographic Index (SDI) levels from 1990 to 2021, calculating age-standardized incidence (ASIR) and death (ASDR) rates, as well as estimated annual percentage changes (EAPCs). RESULTS: Globally, FBA incidence declined by 35.3% between 1990 and 2021 (EAPC: -2.02
95% CI: -2.13 to -1.91), with marked reductions among children under 5 years of age. Nonetheless, total FBA-related deaths rose slightly from 99,329 (95% UI: 80,764-112,381) in 1990 to 103,915 (95% UI: 82,081-113,555) in 2021. While many regions showed improvement, countries such as Italy, Georgia, and Zimbabwe recorded increases in ASIRs. In 2021, children under 5 remained at highest risk of morbidity, while older adults (≥ 70 years), especially in high-income Asia Pacific and Western Europe, showed elevated mortality. Notably, younger children achieved substantial decreases in incidence, death, and DALYs, yet older populations faced modest rises in mortality and DALYs. Higher-SDI regions reported the greatest morbidity and mortality, and high-middle SDI regions exhibited the highest DALYs, YLLs, and YLDs, reflecting the influence of socioeconomic development on FBA burden. CONCLUSIONS: Global FBA incidence declined from 1990 to 2021, yet the number of associated deaths continued to rise, indicating ongoing challenges in prevention and management. High- and middle-high SDI regions carried the greatest burden, with children under 5 and older adults (≥ 70 years) particularly affected. These patterns suggest that both advancing socioeconomic development and population aging influence FBA outcomes. Strengthening surveillance, improving emergency response, and implementing targeted, population-specific prevention strategies are essential for reducing the global FBA burden.