Global Burden and Disparities in Hematologic Malignancies: A Comparative Analysis from 1990 to 2019

Introduction : To explore disparities in socio-demographic development levels across countries and comprehensively examine the burden of hematologic malignancies (HMs), including leukemia, Hodgkin lymphoma(HL), non-Hodgkin lymphoma(NHL), multiple myeloma(MM), as well as myeloproliferative neoplasm(MPN).

Method s：We obtained the estimates, along with their 95% uncertainty interval (UI), for disability-adjusted life-years (DALYs) related to various HMs from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019. We illustrated the age-standardized DALYs rate for these malignancies across 204 countries, along with the global distribution of DALYs rates by age and sex. In order to assess the disparities in the burden of hematologic malignancies, we employed two recommended metrics by the World Health Organization (WHO), namely the slope index of inequality and the concentration index, which quantify absolute and relative gradient inequality, respectively.

R esults：In 2019, across 204 countries, there were remarkable variations in the age-standardized DALYs rate for leukemia, HL, NHL, MM, and MPN, with distinct age and sex distributions significantly impacting the global rate of DALYs.

The slope index of inequality changed from 28.20 (95% CI: -0.87 to 57.27) in 1990 to 46.03 (95% CI: 26.36 to 65.69) in 2019 for leukemia, from 37.87 (95% CI: 30.32 to 45.41) in 1990 to 45.99 (95% CI: 38.16 to 53.82) in 2019 for AML, from -1.60 (95% CI: -6.57 to 3.36) in 1990 to -2.17 (95% CI: -4.73 to 0.38) in 2019 for CML , from 2.14 (95% CI: -6.59 to 10.86) in 1990 to -10.86 (95% CI: -16.02 to -5.70) in 2019 for ALL, from 12.98 (95% CI: 9.46 to 16.50) in 1990 to 22.42 (95% CI: 17.53 to 27.31) in 2019 for CLL, from -37.44 (95% CI: -57.29 to -17.61) in 1990 to -13.63 (95% CI: -25.69 to -1.56) in 2019 for other leukemia, from 6.97 (95% CI: 1.82 to 12.12) in 1990 to 0.45 (95% CI: -2.90 to 3.79) in 2019 for HL, from 73.00 (95% CI: 55.40 to 90.61) in 1990 to 102.83 (95% CI: 87.33 to 118.32) in 2019 for NHL, from 37.90 (95% CI: 30.19 to 45.62) in 1990 to 77.31 (95% CI: 66.34 to 88.28) in 2019 for MM, from 15.56 (95% CI: 12.97 to 18.15) in 1990 to 30.15 (95% CI: 25.72 to 34.58) in 2019 for MPN.

The concentration index showed 0.18 (95% CI: 0.13 to 0.23) in 1990 and 6.95 (95% CI: 6.63 to 7.26) in 2019 for leukemia, 19.22 (95% CI: 17.63-20.80) in 1990 and 17.61 (95% CI: 16.85-18.38) in 2019 for AML, -20.84 (95% CI: -25.58 to -16.10) in 1990 and -20.75 (95% CI: -22.55 to -18.95) in 2019 for CML, -2.83 (95% CI: -3.22 to -2.45) in 1990 and -4.72 (95% CI: -5.05 to -4.39) in 2019 for ALL,37.75 (95% CI: 36.03 to 39.47) in 1990 and 29.12 (95% CI: 27.62 to 30.63) in 2019 for CLL, -3.14 (95% CI: -3.59 to -2.69) in 1990 and 8.56 (95% CI: 7.95 to 9.17) in 2019 for other leukemia,-0.63 (95% CI: -0.68 to -0.58) in 1990 and -13.44 (95% CI: -14.45 to -12.43) in 2019 for HL, 23.25 (95% CI: 22.55 to 23.96) in 1990 and 19.34 (95% CI: 18.55 to 20.13) in 2019 for NHL, 39.05 (95% CI: 37.10 to 41.01) in 1990 and 36.53 (95% CI: 34.66 to-38.40) in 2019 for MM,47.18 (95% CI: 43.52 to 50.84) in 1990 and 47.30 (95%CI: 44.31 to 50.30) in 2019 for MPN.

C onclusion：The age-standardized DALYs rate exhibits significant heterogeneity across all countries, alongside variations in the age and sex distribution of the global rate of DALYs for HMs. Moreover, countries with higher levels of socio-demographic development bear a disproportionate burden of HMs, and the extent of these inequalities related to socio-demographic development levels has worsened over time.