The study analyzed the burden of interstitial lung disease (ILD), pulmonary sarcoid (PS) and lung cancer in adolescents and young adults (15–39 years) in China and G20 countries from 1990 to 2021. Age-standardized prevalence rates, incidence, mortality and disability-adjusted life years (DALYs) for ILD and PS declined in China, with annual percentage changes around -0.5% to -2.5%. Compared to other G20 countries, China ranks 19th to 20th in these indicators for ILD and PS. In contrast, the burden of lung cancer remained high in China, with rates largely leading the G20, with population growth being the main factor increasing lung cancer prevalence and incidence. Projections until 2050 assume a further decline in ILD and PS rates, including mortality and DALYs. The authors emphasize the need for international cooperation for research, prevention and control of these diseases, which represent a significant challenge for public health.