Objectives To investigate the incidence and determinants of glaucoma in an elderly Chinese population, and clinical, mental health and economic impacts. Design This nationally representative, longitudinal study assessed self-reported 6-year (from 2011 to 2018) incident glaucoma diagnosis by a physician and measured biological, clinical and socioeconomical participant characteristics at baseline and endline. Setting In the first stage, 150 county-level units from across China were randomly selected with a probability-proportional-to-size sampling technique from a frame containing all county-level units nationwide. The sample was stratified by region and within region by urban district or rural county and per capita gross domestic product. The final sample of 150 counties included 30 out of 31 provinces and autonomous regions in China. Participants Consenting, community-dwelling Chinese persons aged 50 years and older. Primary and secondary outcome measures Incident glaucoma incidence (primary), factors associated with incident glaucoma (secondary), impact of glaucoma (secondary). Results Among 9973 individuals, 3.4% reported a glaucoma diagnosis between 2011 and 2018; Central China had the highest incidence (3.95%) and Eastern China the lowest (2.64%) between 2011 and 2018. Those diagnosed with glaucoma during 2011 and 2018 were of older age (beta coefficient: 0.050, 95% CI: 0.001, 0.001, p<0.001), had higher prevalence of diabetes (beta coefficient: 0.049, 95% CI: 0.028, 0.032, p<0.001), hypertension (beta coefficient: 0.019, 95% CI: 0.006, 0.008, p<0.001), smoking (beta coefficient: 0.029, 95% CI: 0.004, 0.020, p=0.004), alcohol consumption (beta coefficient: 0.026, 95% CI: 0.002, 0.017, p<0.009) and illiteracy (beta coefficient: -0.057, 95% CI: -0.030, -0.015, p<0.001). Logistic regression models showed significant association between incidence of the following characteristics and baseline glaucoma: poor self-reported distance vision (beta coefficient: 1.106, 95% CI: 0.701, 1.511, p<0.001), having hypertension (beta coefficient: 0.545, 95% CI: 0.496, 0.593, p<0.001), having diabetes (beta coefficient: 0.388, 95% CI: 0.326, 0.449, p<0.001), not having obesity (beta coefficient: -0.184, 95% CI: -0.239, -0.129, p<0.001) and lower mean value of health utility score of residents' quality of life (beta coefficient: -0.040, 95% CI: -0.006, 0.776, p<0.001). Conclusions Glaucoma incidence rate varies among geographical regions in China. Several risk factors for incident glaucoma were identified. In addition, glaucoma was found to be associated with multiple physical and psychosocial outcomes. Targeted public health strategies are needed, emphasising early detection and better vision care, to alleviate the burden of glaucoma and improve well-being.