The global burden and attributable risk factor analysis of acute myeloid leukemia in 195 countries and territories from 1990 to 2017: estimates based on the global burden of disease study 2017

Abstract

Background: Acute myeloid leukemia (AML) is a common leukemia subtype and has a poor prognosis. The risk of AML is highly related to age. In the context of population aging, a comprehensive report presenting epidemiological trends of AML is evaluable for policy-marker to allocate healthy resources.

Methods: This study was based on the Global Burden of Disease 2017 database. We analyzed the change trends of incidence rate, death rate, and disability-adjusted life year (DALY) rate by calculating the corresponding estimated annual percentage change (EAPC) values. Besides, we investigated the influence of social development degree on AML's epidemiological trends and potential risk factors for AML-related mortality.

Results: From 1990 to 2017, the incidence of AML gradually increased in the globe. Males and elder people had a higher possibility to develop AML. Developed countries tended to have higher age-standardized incidence rate and death rate than developing regions. Smoking, high body mass index, occupational exposure to benzene, and formaldehyde were the main risk factors for AML-related mortality. Notably, the contribution ratio of exposure to carcinogens was significantly increased in the low social-demographic index (SDI) region than in the high SDI region.

Conclusion: Generally, the burden of AML became heavier during the past 28 years which might need more health resources to resolve this population aging-associated problem. In the present stage, developed countries with high SDI had the most AML incidences and deaths. At the same time, developing countries with middle- or low-middle SDI also need to take actions to relieve rapidly increased AML burden.

Keywords: Acute myeloid leukemia; Cancer epidemiology; Cancer statistics; Global burden disease; Population aging.

Fig. 1

The change trends of AML’s incidence cases, deaths, and DALYs from 1990 to 2017. a The change trends of incidences, b the change trends of deaths, and c the change trends of DALYs. Blue bars represent males and red bars represent females. Note: AML, acute myeloid leukemia; DALY, disability-adjusted life year

Fig. 2

The global disease burden of AML in 195 countries or territories. a The incidence cases of 195 countries or territories in 2017, b the deaths of 195 countries or territories in 2017, and c the DALYs of 195 countries or territories in 2017. Note: AML, acute myeloid leukemia; DALY, disability-adjusted life year

Fig. 3

The age-standardized rates of AML in 195 countries or territories. a The ASIR of 195 countries or territories in 2017, b the ASDR of 195 countries or territories in 2017, and c the age-standardized DALY rate of 195 countries or territories in 2017. Note: AML, acute myeloid leukemia; ASIR, age-standardized incidence rate; ASDR, age-standardized death rate; DALY, disability-adjusted life year

Fig. 4

The correlation analyses of EAPCs-ASIR (1990) and EAPCs-SDI (2017). a The correlation between EAPC of ASIR and ASIR of 1990 in 195 countries or territories, b the correlation between EAPC of ASIR and SDI of 2017 in 195 countries or territories, c the correlation between EAPC of ASDR and SDI of 2017 in 195 countries or territories, and d the correlation between EAPC of age-standardized DALY rate and SDI of 2017 in 195 countries or territories. The size of circle represents the quantity of AML patients in one country or territory. Note: AML, acute myeloid leukemia; ASIR, age-standardized incidence rate; ASDR, age-standardized death rate; DALY, disability-adjusted life year; EAPC, estimated annual percentage change; SDI, socio-demographic index

Fig. 5

The change trends and correlation analyses of ASRs and SDI from 1990 to 2017. a The change trends and correlation of ASIR and SDI from 1990 to 2017 in 21 regions. b The change trends and correlation of ASDR and SDI from 1990 to 2017 in 21 regions. c The change trends and correlation of age-standardized DALY rate and SDI from 1990 to 2017 in 21 regions. Note: AML, acute myeloid leukemia; ASIR, age-standardized incidence rate; ASDR, age-standardized death rate; DALY, disability-adjusted life year; EAPC, estimated annual percentage change; SDI, socio-demographic index

Fig. 6

The incidence cases and corresponding ASIR of AML in different age groups from 1990 to 2017. a The incidence cases of AML in five different age groups in the globe and various regions. b The ASIR of AML in five different age groups in the globe and various regions. Note: AML, acute myeloid leukemia; ASIR, age-standardized incidence rate; SDI, socio-demographic index

Fig. 7

Risk factors contributing to AML-related death and DALY. a The four risk factors contributing to AML-related death from 1990 to 2017 in the globe and different regions; b the four risk factors contributing to AML-related DALY from 1990 to 2017 in the globe and different regions; Note: AML, acute myeloid leukemia; DALY, disability-adjusted life year; SDI, socio-demographic index