Background <p>Behavioral and metabolic factors, such as smoking and high fasting plasma glucose (FPG), have been recognized as important risk factors for bladder cancer. This study aims to assess the global and Chinese burden of bladder cancer attributable to these factors and analyze long-term trends.</p> Methods <p>Data from the Global Burden of Disease (GBD) 2021 study were used. Indicators such as the number and rate of deaths and disability-adjusted life years (DALYs) were used to elucidate the disease burden. Joinpoint regression analysis and age-period-cohort models were applied to assess changes in the disease burden over different periods and the independent effects of age, period, and birth cohort.</p> Results <p>From 1990 to 2021, the global burden of bladder cancer attributable to smoking increased, with a decrease in the age-standardized mortality rate (ASMR) and age-standardized DALY rate (ASDR) by 38.09% and 40.78%, respectively. The global burden attributable to high FPG showed a rising trend in ASMR and ASDR, with percentage increases of 20.96% and 15.79%, respectively. In China, smoking-related trends were similar to the global pattern, but high FPG data showed more fluctuation. The age-period-cohort model showed increasing burden with age, except in the very elderly. Smoking-related burden decreased significantly across different periods and birth cohorts. For high FPG, the trend in China was more volatile. The risk was higher in earlier birth cohorts, followed by gradual improvement, but a recent rebound in risk was observed in the latest cohorts. The global cohort effect remained relatively stable.</p> Conclusions <p>This study, based on GBD 2021, highlights the significant impact of behavioral and metabolic factors on bladder cancer burden globally and in China, with differing trends. China should strengthen tobacco and blood glucose management, focus on targeted interventions for the elderly, and enhance health education for the younger population to improve public health.</p>