The Burden of Leukemia in the United States from 1990 to 2021
Authors: Saadeh Aseel , Al-Bitar Farah , Al Ta'ani Omar , Abdulelah Ahmed A , Usmani Asra Abeer , Jibrin Dayana , Haddadin Michael , Scott Katie 
Published: December 2024

Introduction
Leukemia, a heterogeneous group of hematologic malignancies, continues to significantly impact cancer-related morbidity and mortality in the United States. Despite advancements in therapeutic and diagnostic modalities, the burden of leukemia remains substantial. Previous studies have explored the incidence and survival trends of various leukemia subtypes, highlighting disparities based on demographics such as age, sex, race, and geographic location . Our study aims to build on this knowledge by providing a comprehensive analysis of leukemia trends over the past three decades, with a focus on subtype variations and state-specific differences. Utilizing data from the Global Burden of Disease (GBD) database, we seek to highlight these patterns to inform targeted healthcare strategies and resource allocation.
Methods
Data on annual leukemia cases, deaths, disability-adjusted life years (DALYs), age-standardized incidence rates (ASIRs), age-standardized mortality rates (ASMRs), and age-standardized DALYs rate (ASDR) from 1990 to 2021 were collected. Percentage changes as well as the estimated annual percentage change (EAPC) in ASIRs, ASMRs, and ASDRs were calculated. EAPCs were determined via linear regression, and correlations with the Socio-demographic Index (SDI) were assessed using Pearson correlation analyses. All analyses were conducted using R programming version 4.3.3.
Results
In 1990, there were 21,859 (20,543 - 22,559) deaths attributable to leukemia, while there was 29,785.98 (26,704 - 31,337) in 2021, a 36.3% increase. However, the ASMR for leukemia in the US decreased from 6.97 per 100,000 in 1990 to 5.17 per 100,000 in 2021, a 25.82% decrease, an EAPC of -1.04% (-1.14 - -0.939). The ASIR decreased from 13.50 (12.91- 13.84) per 100,000 to 9.81 (9.11 - 10.22) per 100,000, a 27.33% drop. The ASDR decreased from 210.71 (205.12 - 214.98) per 100,000 to 132.89 (125.97 - 137.57) per 100,000, a 36.93% drop. While all the major subtypes of leukemia witnessed a decrease in ASIR and ASMR, acute myeloid leukemia witnessed a 11.27% and 1.75% increase, respectively. Hawaii remained the state with the lowest ASDR, recording 163.4 per 100,000 (154.2 - 171.4) in 1990 and 105.2 per 100,000 (89.0-121.31) in 2021. In contrast, the District of Columbia had the highest ASDR in 1990 with 300.9 per 100,000 (285.4 - 315.7), while Mississippi had the highest in 2021 with 181.6 per 100,000 (154.1 - 209.2). DALYs attributable to leukemia varied significantly between states, and there was a significant negative correlation between DALYs and the SDI in 2021 (p= -0.78, p-value &lt;0.001).
Discussion
Our analysis reveals a significant decline in leukemia mortality and incidence rates in the United States over the past three decades, highlighting advancements in therapeutic and diagnostic modalities. Despite these overall positive trends, acute myeloid leukemia (AML) exhibited an increase in incidence and mortality, highlighting ongoing challenges in its management. The negative correlation between DALYs and the Socio-demographic Index (SDI) suggests that socio-economic factors significantly influence leukemia outcomes, emphasizing the need for targeted healthcare strategies to address these disparities. Our study demonstrates the importance of continued efforts to improve leukemia treatment and address socio-economic disparities in healthcare.