Background and Aims <p>Hepatitis E virus (HEV) infection poses an increasing threat to the health of older adults, yet global epidemiological data on this susceptible population remain limited. This study aims to evaluate long-term trends in the incidence and mortality of acute hepatitis E (AHE) among individuals aged 60 years and older, with a focus on demographic, regional, and socioeconomic disparities.</p> Methods <p>In this study, we used GBD data from 2021 to assess the incidence and mortality rates associated with the HEV in older populations. We quantified incidence rates, determined average annual percentage changes, and analysed global trends across age, sex, and socio-demographic index (SDI) levels. Health inequality was evaluated via the Slope Index of Inequality (SII) and Concentration Index (CI). Additionally, we employed the Bayesian Age-Period-Cohort model to project the incidence of and mortality from HEV among older adults by 2030.</p> Results <p>From 1990 to 2021, the global age-standardized incidence of AHE among older adults remained stable, while mortality declined (AAPC: − 2.9%). Notably, incidence increased substantially within the oldest age groups, particularly among those aged 75–94 years, and was consistently higher in females than in males across all age groups. Mortality decreased across most age groups, with the most pronounced reductions in individuals under 80. Substantial regional and socioeconomic disparities persisted, with low-SDI countries bearing a heavier burden. By 2030, incidence is expected to rise with age, while male mortality will remain markedly higher than that of females.</p> Conclusions <p>The burden of AHE among older adults remains substantial and unequally distributed. As the global population ages, targeted interventions are urgently needed to reduce disease burden and health disparities.</p>