The Burden of Hematologic Malignancies in Southeast Asia from 1990 to 2021: Estimates from the Global Burden of Disease Study
Authors: Ho Frances Dominique V. , Dee Edward Christopher , Feliciano Erin Jay G. , Jain Urvish , Sekolar Aryan , Jain Bhav , Columbres Rod Carlo , Swami Nishwant , Wu James Fan 
Published: December 2024

Introduction: With a population of nearly 700 million, Southeast Asia has immense epidemiologic diversity. Better understanding of the burden of hematologic malignancies (HMs) will galvanize regional informed research and policymaking.

Methods: Using the Global Burden of Diseases, Injuries, and Risk Factors Study 2021 (GBD 2021), we extracted age-standardized incidence and mortality rates (ASIR and ASMR) and disability adjusted life-years (DALYs) per 100,000 person-years for HMs. 2021 and 1990-2021 trend data for leukemia, non-Hodgkin lymphoma (NHL), multiple myeloma (MM), and Hodgkin lymphoma (HL) in the world, the Association of Southeast Asian Nations (ASEAN), and the 10 individual ASEAN countries are presented.

Results: In 2021, the burden of HMs in ASEAN was driven by Indonesia and Thailand. Indonesia had the highest burden with 21,241 new cases, 18,663 deaths, 740,704 DALYs. Thailand had the second highest with 11,099 new cases, 8,084 deaths, 246,746 DALYs. Leukemia and NHL had the most and second most new cases in ASEAN, Cambodia, Indonesia, Laos, the Philippines, Malaysia, Myanmar, and Thailand but vice versa in other countries. Leukemia had the most new cases, deaths, and DALYs in both sexes.

In 2021, for leukemia, ASIR, ASMR, DALYs in ASEAN were 4.7, 4.4, 172.7 versus 5.6, 3.9, 136.9 globally; ASIR was highest in Thailand (6.1) and lowest in Vietnam (2.9). ASMR and DALYs were highest in Cambodia (5.9 and 230.2) and lowest in Singapore (2.5 and 87.6). From 1990 to 2021, all countries had relative decreases in ASIR but Thailand (+1.7%) with the largest decrease in Myanmar (-31.4%). All countries had relative decreases in ASMR and DALYs with the largest in ASMR in Singapore (-44.8%) and DALYs in Thailand (-57.4%).

In 2021, for NHL, ASIR, ASMR, DALYs in ASEAN were 3.7, 2.7, 85.3 versus 7.1, 3.2, 93.1 globally. ASIR and ASMR were highest in Brunei (8.5 and 6.2) and lowest in Indonesia (2.9) and the Philippines (2.5), respectively. DALYs were highest in Thailand (186.3) and lowest in Singapore (73.5). From 1990 to 2021, most countries had relative increases in ASIR but Laos (-1.4%) and Myanmar (-6.0%) with the largest increase in Thailand (+55.5%). For ASMR, Cambodia, Vietnam, Indonesia, the Philippines, and Malaysia had relative increases with the largest in Cambodia (+17.4%) while the other countries had relative decreases. Similar to ASMR, relative increases in DALYs were seen in the same countries plus Thailand, which had the largest (+97.9%). Singapore had the largest relative decreases in both ASMR and DALYs (-23.9% and -31.1%).

In 2021, for MM, ASIR, ASMR, DALYs in ASEAN were 0.50, 0.44, 11.0 versus 1.7, 1.4, 30.0 globally. ASIR, ASMR, DALYs were highest in Brunei (2.4, 2.2, 48.0). ASIR and ASMR were lowest in Vietnam (0.32 and 0.27) while DALYs were lowest in Thailand (4.2). From 1990 to 2021, most countries had relative increases in ASIR and ASMR but Brunei (-8.2% and -14.8%) and Singapore (-21.2% and -38.4%) with the largest increase in Vietnam (+141.2% and 112.0%). Most countries had relative increases in DALYs but Brunei, Singapore, and Thailand (-16.4%, -44.1%, and -56.4%) with the largest increase in Vietnam (+109.9%).

In 2021, for HL, ASIR, ASMR, DALYs in ASEAN were 0.35, 0.18, 6.9 versus 0.79, 0.34, 14.8 globally. ASIR was highest in Vietnam (0.73) and lowest in the Philippines (0.18). ASMR was highest in Brunei (0.35) and lowest in Singapore (0.09). DALYs were highest in Thailand (14.1) and lowest in Singapore (3.0). From 1990 to 2021, Brunei (-1.1%), Cambodia (-29.1%), Indonesia (-20.9%), Laos (-41.7%), and Myanmar (-41.5%) had relative decreases in ASIR while Vietnam (+33.3%), Singapore (+18.1%), the Philippines (+3.2%), Malaysia (+7.3%), and Thailand (+35.9%) had relative increases. All countries saw relative decreases in ASMR and DALYs but Thailand in DALYs (+93.2%). Singapore had the largest relative decreases in ASMR and DALYs (-57.3% and -59.1%).

Conclusions: While ASIR, ASMR, and DALYs for HMs in ASEAN are lower than global rates, substantial intra-regional variations warrant more country-specific research. Underreporting may result in underestimation of true HM burden. Efforts are needed to further characterize the burden of HMs in ASEAN and elucidate the mechanisms that underlie cross-country differences to improve diagnostic and treatment access and encourage cross-country collaboration.