Global and Regional Burden of Chronic Lymphocytic Leukemia from 1980 to 2021:an Analysis of Gbd Study 2021

Introduction

Chronic lymphocytic leukemia (CLL) is a mature B-cell lymphoma primarily affecting elderly males and is estimated to be the most prevalent leukemia in developed countries. While the incidence of CLL has been documented to be increasing in recent years with an aging population, trends in CLL associated mortality remain understudied and less well-defined.

Methods

This study utilized data from the publicly available Global Burden of Diseases (GBD) database from 1980 to 2021, in order to examine chronic lymphocytic leukemia metrics, including age-standardized death rates (ASDR), Years of Lost Life (YLL), and disability-adjusted life years (DALYs). The global data were stratified by continent, socio-demographic index (SDI), and World Bank income groups. We applied the Joinpoint Regression Program to quantify trends and average annual percentage changes (AAPC) over the predetermined study period.

Results:

CLL-related global ASDRs declined over the study period from 1980 to 2021. In 1980, the global ASDR was 0.80 (95% UI: 0.72-0.88), which decreased to 0.55 by 2021 (AAPC= -0.88; 95% CI: -0.90 to -0.86). The steepest decline in ASDRs occurred from 2012 till 2015 (APC= -2.77; 95% CI: -2.99 to -2.36). The global disability-adjusted life years (DALYs) rate for CLL also decreased from 18.10 (95% UI: 15.44-19.95) in 1990 to 11.81 in 2021 (AAPC= -1.37; 95% CI: -1.39 to -1.35). The age-standardized years of life lost (YLL) due to CLL followed a similar trend and declined from 17.00 (95% UI: 14.59-19.84) in 1980 to 10.74 (95% UI: 8.34-12.37) in 2021 (AAPC= -1.10; 95% CI: -1.12 to -1.09). When analyzed by continent for contemporary rates, the highest ASDRs were observed in Europe (2021 ASDR= 0.99, 95% UI: 0.89-1.07). Further examination revealed that while initially both Europe and North America demonstrated comparable declining trends in ASDRs, North America experienced a steeper decline than Europe (Europe: AAPC= -0.33, 95% CI: -0.37 to -0.28; North America= AAPC: -1.12, 95% CI: -1.16 to -1.08), hence leading to a difference in contemporary ASDRs between the two. Of the 4 continents that were examined in detail, Asia had the lowest ASDRs and experienced a steady decrease over the study period (AAPC= -0.59, 95% CI: -0.61 to -0.58). Africa was the only continent where ASDRs demonstrated a rising trend from 1980 to 2021 (AAPC= 0.20, 95% CI: 0.19 to 0.22). High income level countries and high SDI regions had higher ASDRs than middle-, low-middle-, and lower-income countries, and low SDI regions.

Conclusion:

CLL is a highly prevalent hematologic malignancy among adults and poses a significant public health challenge. CLL-related mortality declined sharply in Europe and North America, which may be attributable to the availability of novel diagnostic techniques and therapies. There has been a concerning rise in mortality in Africa, which underscores potential disparities in the availability of health resources.

No relevant conflicts of interest to declare.