Global, regional, and national burdens of leukemia from 1990 to 2019: A systematic analysis of the global burden of disease in 2019 based on the APC model

Abstract

Background: Leukemia is the tenth most common cause of cancer death worldwide and one of the most important causes of disability. To understand the current status and changing trends of the disease burden of leukemia at the global, regional, and national levels, and to provide a scientific basis for the development of leukemia prevention and treatment strategies.

Methods: Based on open data from the Global Burden of Disease Study 2019 (GBD 2019), R software was used to calculate estimated annual percentage changes to estimate trends in the age-standardized incidence (ASIR) and the age-standardized disability-adjusted life years (DALY) rate due to leukemia and its major subtypes from 1990 to 2019.

Results: In 2019, globally, the number of incidences and DALYs of leukemia were 643.6 × 10³ (587.0 × 10³, 699.7 × 10³) and 11,657.5 × 10³ (10529.1 × 10³, 12700.7 × 10³), respectively. The ASIR (estimated annual percentage change (EAPC) = -0.37, 95%UI -0.46 to -0.28) and the age-standardized DALY rate (EAPC = -1.72, 95%UI -1.80 to -1.65) of leukemia showed a decreasing trend from 1990 to 2019. The APC model analysis showed that the age effect of leukemia risk was a "U"-shaped distribution of relative risk (RR) with increasing age from 1990 to 2019, globally. The time effect was an increase in incidence rate with increasing years but a decrease in DALY rate with increasing years. The cohort effects of both incidence and DALY rates tended to increase and then decrease with the development of the birth cohort. In 1990 and 2019, smoking, high body-mass index, occupational exposure to benzene, and occupational exposure to formaldehyde were risk factors for DALY in leukemia, especially in areas with high SDI.

Conclusions: From 1990 to 2019, the disease burden of leukemia showed a decreasing trend, but it is worth noting that its overall severity is still very high. The disease burden of leukemia varies greatly from region to region, and exclusive strategies for the prevention and treatment of leukemia should be developed according to the economic and cultural development of each region.

Keywords: age‐period‐cohort model; burden of disease; disability‐adjusted life years; estimated annual percentage change; leukemia.

FIGURE 1

Global compared with the different SDI regions for Incidence (A), DALY rate (B), ASIR (C), and the age‐standardized DALY rate (D). The Y‐axis represents the disease burden globally and in different SDI regions, and the X‐axis represents year. Four figures depict disease burden for different indicators in different regions. ASIR, age standardized incident rate; DALY, disability‐adjusted life years; SDI, socio‐demographic index.

FIGURE 2

The global disease burden of Leukemia for both sexes in 204 countries and territories. (A) The number of Leukemia cases in 2019; (B) The ASIR of Leukemia in 2019; (C) The EAPC of the ASIR of Leukemia from 1990 to 2019. ASIR, age standardized incident rate; EAPC, estimated annual percentage change.

FIGURE 3

The ASIR (A) and the age‐standardized DALY rate (B) for the five subtypes of Leukemia, globally and regionally, 1990 and 2019. ASIR, Age standardized incident rate. DALY, Disability‐adjusted life years.

FIGURE 4

The ASIR of leukemia for 21 GBD regions (A) and 204 countries and territories (B) by Socio‐demographic Index, 1990–2019. Expected values based on Socio‐demographic Index and disease rates in all locations are shown as the black line. The black line represents the expected ASIR and SDI in 204 countries and territories. Each point shows the observed ASIR for a specified country in 2019. ASIR, Age standardized incident rate; GBD, Global Burden of Disease; SDI, Socio‐demographic index.

FIGURE 5

The global disease burden of Leukemia for both sexes in 204 countries and territories. (A) The number of DALY cases of Leukemia in 2019; (B) The age‐standardized DALY rate of Leukemia in 2019; (C) The EAPC of the age‐standardized DALY rate of Leukemia from 1990 to 2019. DALY, disability‐adjusted life years; EAPC, estimated annual percentage change.

FIGURE 6

The model diagram of Age‐Period‐Cohort effect estimates for global leukemia. (A) Age‐period‐cohort analysis of Incidence; (B) Age‐period‐cohort analysis of DALY rate. To avoid the involvement of multiple dimensions of influencing factors in the disease progression process, we employed the APC model to decompose the disease progression into multiple dimensions. By analyzing the model, we obtained the true effects of the leukemia. Each age group is represented by different cohorts in different periods. The age distribution of each period is a function of age and period. APC, Age‐Period‐Cohort; DALY, Disability‐adjusted life years.

FIGURE 7

The leukemia DALYs attributable to risk factors in 1990 and 2019. In 1990 and 2019, smoking, high body‐mass index, occupational exposure to benzene and occupational exposure to formaldehyde were risk factors for leukemia DALY, especially in areas with high SDI. From 1990 to 2019, there were gender differences in the burden of leukemia disease caused by smoking and high body‐mass index worldwide. (A) Global risk factor attribution analysis in 1990, (B) global risk factor attribution analysis in 2019, (C) global risk factor attribution analysis for men in 1990, (D) global risk factor attribution analysis for men in 2019, (E) global risk factor attribution analysis for female in 1990, and (F) global risk factor attribution analysis for female in 2019. DALY, Disability‐adjusted life years.