Objective Tetanus is a serious infectious diseases with high mortality, which is an important global public health issue. This study aims to analyze the epidemiological burden and changing trends of tetanus in China from 1990 to 2021, providing a basis for disease prevention and control. Methods Epidemiological indicators and global socio-demographic index (SDI) related to tetanus in China were retrieved and collected from the 2021 Global Burden of Disease database (GBD 2021). The trend analysis of the incidence rate, mortality rate and disability-adjusted life years (DALYs) rate of tetanus in China from 1990 to 2021 was conducted by Joinpoint 5.3 software. Results From 1990 to 2021, the age-standardized incidence rate (ASIR), age-standardized mortality rate (ASMR), and age-standardized disability-adjusted life years (DALYs) rate of tetanus in China decreased significantly (average annual percent change ［AAPC］<0, P<0.001), with males being significantly higher than females. The crude incidence rate, crude mortality rate, and crude DALYs rate for all age groups showed overall declining trends, with the largest decline in the 0-14 years age group. In 2021, the crude incidence rate, crude mortality rate, and crude DALYs rate of tetanus in the population aged 70- years were higher than those in the population aged 0-14, 15-49, and 50-69 years groups. The ASIR, ASMR, and age-standardized DALYs rate of tetanus in China in 2021 were lower than the global level, only higher than those in the high SDI regions. Conclusion From 1990 to 2021, the disease burden of tetanus in China varied with gender and age, with an overall declining trend over time. It is necessary to strengthen tetanus health education for males and the ≥70 years population, and to improve the overall level of primary prevention measures for tetanus.