Evolving Burden of Multiple Myeloma and Its Trend in European Union Countries from 1990-2021: A Secondary Analysis from the Global Burden of Disease Study 2021
Authors: Modi Shivani , Syed Saifullah , Shandilya Ashwinikumar , Durga Divya , Yadav Ratan PAL , Lakkimsetti Mohit , Amin Vishrant , Patel Juhi , Jain Hardik , Desai Hardik Dineshbhai , Markandu Keethanshan , Dharia Adit Alpesh 
Published: December 2024

Multiple myeloma (MM) poses a significant health burden, affecting both patients and healthcare systems in the European Union. Over the past three decades, advancements in diagnostic techniques and therapeutic interventions have altered the disease landscape, yet the overall incidence and mortality rates remain a concern. Understanding the temporal trends and burden of multiple myeloma in the EU from 1990 to 2021 is crucial for informing healthcare policies, resource allocation, and future research directions aimed at improving patient outcomes.

We utilized the global burden of disease methodology to estimate the incidence, prevalence, mortality, and disability-adjusted life years (DALYs) associated with MM in EU countries from 1990 to 2021, broken down by age, sex, year, and location. Non-fatal health outcomes were calculated using DISMOD MR 2.1, a meta-regression machine learning tool. Fatal health outcomes were calculated using the Cause of Death Ensemble Model (CODEm). The results are reported as absolute counts and age-standardized rates per 100,000 person-years.

The total prevalence count increased from 47,418 (95% uncertainty interval: 44,677-50,118) in 1990 to 118,505 (107,905-126,755) in 2021. During the same period, deaths rose from 13,882 (13,143-14,382) to 25,741 (22,797-27,640), and DALYs from 302,563 (289,695-312,459) to 483,175 (438,873-513,384). The highest annual percentage change (APC) in age-standardized incidence rate (ASIR) was observed in Estonia at 2.94%, followed by Bulgaria at 2.91%, Latvia at 2.74%, Lithuania at 2.39%, and Poland at 1.75%. Conversely, the largest decrease was noted in Sweden at 0.34% from 1990 to 2021. Regarding the age-standardized mortality rate (ASMR), the largest increases were in Bulgaria at 2.66%, Latvia at 2.15%, Estonia at 2.03%, and Lithuania at 1.81%. The total percentage of change (TPC) in ASIR rose by 28%, ASMR by 8%, and age-standardized DALY rate (ASDALR) by 1% from 1990-2021 in the EU. By age group, the highest incidence in 2021 was observed in the 70-74 age group with 6,132 cases (5,526-6,701), deaths in the 80-84 age group with 4,794 (3,976-5,309), and DALYs in the 70-74 age group with 83,750 (77,359-88,926). In terms of gender, males had a higher overall burden compared to females, with the TPC in incidence for males versus females at 171% vs 84%, DALYs at 71% vs 48%, and deaths at 102% vs 70% from 1990 to 2021.

Deaths due to MM accounted for 1.95% of all cancer related causalities in EU countries in 2021. The findings highlight a significant escalation in the burden of disease from 1990 to 2021 across the EU, signaling a pressing need for enhanced diagnostic and therapeutic strategies, particularly in countries like Estonia, Bulgaria, and Latvia. Public health initiatives must focus on targeted interventions that address the underlying risk factors and disparities, with a special emphasis on the growing impact among older age groups and the pronounced gender disparities where males have shown higher incidence and worse outcomes. This study underscores the urgent need for an integrative approach to healthcare, combining preventive measures, chronic disease management, and tailored treatment strategies, urging policymakers, healthcare providers, and researchers to collaborate in strengthening health systems to effectively manage and mitigate these trends to improve overall population health in the coming decades.