Global Incidence, Mortality and Risk Factors of Hodgkins and Non-Hodgkins Lymphoma 1990-2021: A Global Health Data Study

Introduction:

Lymphoma constitutes about 4% of all newly diagnosed cancer cases and 3.3% of cancer related deaths in 2024 in the US. We aim to investigate the epidemiological trends (incidence and death rates) and the risk factors of Lymphoma at global and regional level.

Methods:

The study analyzed data from 1990 to 2021, obtained from the Global Health Data Exchange (GHDx) 2021 database which is a comprehensive catalog of global health and demographic data, providing access to a wide range of datasets around the world. This study described the age-standardized rates (per 100,000 patient- years) of incidence (ASIR), death (ASDR) and attributable risk factors of lymphoma subtypes (Hodgkin: HL and Non-Hodgkin: NHL, Burkitts: BL, other Non-Hodgkin: O-NHL). Regions were stratified by Sociodemographic Index (SDI) ranged from 0 (minimal development) to 1 (maximal development) and was classified as high (>0.715), high-middle (0.625 to .0715), middle (0.558-0.624), low-middle (0.378 to .0557), and low (<0.378) SDI regions. Geographic locations were defined based on World Bank (WB) regions (South Asia, East Asia & Pacific, Europe & Central Asia, North America, Latin America & Caribbean, Middle East & North Africa, Sub-Saharan Africa). We used autoregressive model on the training set up till year 2021 and that model is used for prediction till 2040.

Results:

In 2021, global incidence of NHL, HL, BL, and O-NHL were 604554, 65182, 19072, and 585481 cases respectively. The mortality rate attributed to NHL, HL,BL and O-NHL were 267061, 28179, 6525, and 260535 respectively.

From 1990 to 2021, the ASIR and ASDR of HL decreased (Annual percentage change (APC) of ASIR: M: -0.30, F: -0.28 and ASDR: M: -0.48, F: -0.44). For NHL, the ASIR increased (APC: Male(M): 0.19, Female(F): 0.16) but the ASDR decreased (APC: M: -0.12, F: -0.11). However, the ASDR of BL increased for the same time period (APC: M: 0.18, F: 0.19) but decreased for O-NHL (APC: M: -0.13, F: -0.12).

High BMI was identified in the dataset as a risk factor for deaths in NHL, contributing to 5.26% of deaths in females and 4.47% in males globally in 2021. From 1990 to 2021, Age-Standardized deaths (ASD) associated with high BMI increased in NHL (APC of ASD: F: 28.60%, M: 35%), BL, and O-NHL. No risk factor data for HL was identified in the dataset.

By SDI Region:In 2021, for NHL and HL, the ASIR was highest in high SDI region (NHL: M: 16.5, F: 9.82; HL: M: 1.67, F: 1.19), ASDR was highest in high SDI for NHL (M: 5.09, F: 3.07) and in low SDI region for HL (M: 0.88, F: 0.53). From 1990 to 2021, most of the SDI regions showed decreasing trend in ASDR for HL and NHL except for NHL in females of low (APC: 0.15) and low-middle SDI regions (APC: 0.23). From 1990 to 2021, for NHL, the highest increase in ASD due to high BMI was observed in the low-middle SDI region for males (APC: M: 83.13%). For BL, ASD has doubled for males in Low-middle (117.93%) and low SDI regions (103.84%).

By World Bank Region: In 2021, for NHL the highest ASIR and ASDR were observed in the North America region. From 1990 to 2021, most of the regions showed down trending ASDR for HL and NHL with highest in North America for NHL (APC: M: -0.33, F: -0.35) and East Asia & Pacific for HL (APC: M: -0.64, F: -0.64). Most regions showed an increasing trend of ASIR for NHL and a decreasing trend for HL. In 2021, for NHL, the highest percentage of ASD related to high BMI was recorded in North America for males (7.58%) and Middle East and North Africa for females (8.13%). From 1990 to 2021, for NHL, all the WB regions showed an increase in ASD due to high BMI, with the highest in the South Asia region for males (APC: 89.13%) and females (APC: 78.5%). O-NHL showed similar trends. For BL, ASD due to high BMI has doubled for males in Sub-Saharan Africa (APC: 130.38%) and the Middle East & North Africa (104.84%), and for females in East Asia & Pacific (106.38%).

Our analysis predicts that by 2040, the incidence and death rate for both sexes will decrease for HL, while for NHL, the incidence rate will rise but the death rate will stabilize.

Conclusions:

In this large GHDx dataset, ASDR and ASIR of HL have been decreasing from 1990 to 2021.Although the ASIR for NHL has increased, the ASDR has decreased overtime. High BMI was identified as a risk factor contributing to NHL deaths. In 2021, the highest percentage of NHL ASD secondary to high BMI was in high SDI and North America. These findings highlight gender and regional disparities in the incidence, mortality and risk factors of lymphoma.

Jagadeesh:AstraZeneca, ATARA Biotherapeutics, Debio Pharma, LOXO Pharmaceuticals, MEI Pharma, Regeneron Pharmaceuticals, Inc., Seagen, Trillium Pharmaceuticals: Research Funding; Affimed, Daiichi Sankyo: Membership on an entity's Board of Directors or advisory committees.