Global, Regional and National Burden of Leukemia, 1990-2021: Analysis of Data from the Global Burden of Disease Study 2021
Authors: Yun Zhangjun , Zhang Yayue , Wang Jing , Xue Chengyuan , Wu Jieya , Han Xinpu , Liu Zhu , Zhang Yu , Qi Yubo , Hou Li 
Published: December 2024

Background: The outcome of leukemia has improved markedly over the past several decades, but the survival of leukemia patients varies regionally. A comprehensive epidemiological investigation is necessary to assess the global burden of leukemia.
Methods: In this trend analysis based on the Global Burden of Disease Study (GBD) 2021, we reported incidence, rates per 100,000 population, and disability-adjusted life-years (DALYs) of leukemia at global, regional, and national levels, and their average annual percentage changes (AAPCs) from 1990 to 2021. We further assessed these global trends according to the Society Development Index (SDI). Bayesian age-period-cohort model was used to predict the disease burden of leukemia in 2050, and joinpoint regression analysis was performed to identify the years with the largest changes in global trends.
Results: Globally, new cases of leukemia increased from 311,648 in 1990 to 461,423 in 2021, and were expected to rise to 519,540 in 2050. Of the new cases in 2021, 57.15% (263,712 cases) were male, 70.88% (327,078 cases) were middle-aged or older (&gt; 45 years), and acute myeloid leukemia (144,656 cases, 31.35%) remained the most common subtype. The age-standardized incidence (per 100,000 population) of leukemia has declined significantly (AAPC -0.66 [95% confidence interval (CI) -0.74 to -0.58], p-value &lt; 0.001) from 6.89 (95% uncertainty interval [UI] 6.22 to 7.49) in 1990 to 5.63 (95% UI 4.83 to 6.17) in 2021, with mortality (AAPC -1.16 [95% CI -1.23 to -1.09], p-value &lt; 0.001) from 5.56 (95% UI 4.97 to 6.13) to 3.89 (95% UI 3.34 to 4.25) and DALYs (AAPC -1.64 [95% CI -1.72 to -1.55], p-value &lt; 0.001) from 266.31 (95% UI 195.52 to 258.90) to 136.94 (95% UI 111.89 to 153.71). Joinpoint regression analysis revealed that from 1990 to 2021, the year with significantly increased incidence was 1996 (APC 0.15 [95% CI 0.01 to 0.28], p-value = 0.037), and significantly decreased in 2010 (APC -0.64 [95% CI -0.69 to -0.60], p-value &lt; 0.001), 2019 (APC -0.88 [95% CI -0.98 to -0.78], p-value &lt; 0.001), and 2021 (APC -2.18 [95% CI -3.23 to -1.12], p-value &lt; 0.001). By SDI quintile, leukemia incidence and mortality in 2021 showed a positive association with SDI, with high SDI and high-middle SDI regions exhibiting higher incidence than global levels. Only high-middle SDI regions failed to show a significant decrease in incidence from 1990 to 2021 (AAPC -0.16 [95% CI -0.40 to 0.08], p-value = 0.200). High SDI regions showed the largest decreased incidence from 1990 to 2021 (AAPC -0.59 [95% CI -0.68 to -0.49], p-value &lt; 0.001). Mortality and DALYs declined significantly at all five SDI regions from 1990 to 2021 (AAPC p-value &lt; 0.001). At the 26-region level, Australasia (10.61 [95% UI 9.73 to 11.57]), High-income North America (5.09 [95% UI 4.62 to 5.33]) and Andean Latin America (205.53 [95% UI 151.29 to 253.23]) had the highest incidence, mortality and DALYs, respectively. For the period 1990 to 2021, Northern Africa (AAPC 0.74 [95% CI 0.58 to 0.90], p-value &lt; 0.001), Southern Sub-Saharan Africa (AAPC 0.38 [95% CI 0.19 to 0.57], p-value &lt; 0.001) and Southern Sub-Saharan Africa (AAPC 0.12 [95% CI -0.06 to 0.30], p-value = 0.201) had the largest increase in leukemia incidence, mortality, and DALYs. At the 204-country level, Greece (11.53 [95% UI 10.66 to 12.30]), Afghanistan (9.98 [95% UI 5.97 to 14.58]), and Afghanistan (373.66 [95% UI 215.70 to 553.13]) presented the highest incidence mortality and DALYs of leukemia. Slovenia (AAPC 1.44 [95% CI 1.25 to 1.63], p-value &lt; 0.001), Lesotho (AAPC 1.74 [95% CI 1.54 to 1.93], p-value &lt; 0.001), and Tokelau (AAPC 2.87 [95% CI 2.48 to 3.27], p-value &lt; 0.001) were the countries with the largest increased incidence and mortality and DALYs of leukemia, respectively. Age was grouped every five years, with the highest increased incidence (AAPC 0.37 [95% CI 0.23 to 0.51], p-value &lt; 0.001) and prevalence (AAPC 1.33 [95% CI 1.10 to 1.55], p-value &lt; 0.001) occurring from 1990 to 2021 in the age group of 90 to 94 years.
Conclusion: Despite the significant decline in incidence, mortality, and DALYs of leukemia globally over the past 31 years, the number of new cases of leukemia is continuing to rise owing to population growth, and an even greater burden of disease will be faced in 2050. Notably, the burden of leukemia varies across regions and countries, and there is an urgent need for innovative and personalized prevention and care strategies to reduce the burden of leukemia globally.