Han Xinpu, Yun Zhangjun, Liu Zhu, Si Yuping, Tian Shaodan, Zhang Yu, Qi Yubo, Xue Chengyuan, Cui Meichen, Wen Xu, Zhang Yayue, Hou Li
Department of Oncology and Hematology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, 100700, China.
Beijing University of Chinese Medicine, Beijing, 100029, China.
Biomed Eng Online. 2025 Jun 10;24(1):72. doi: 10.1186/s12938-025-01403-7.
Despite therapeutic advances, acute leukemia (AL) continues to impose a substantial global health burden, with persistently high incidence and mortality rates. Notably, the prediction is that the number of incidence and mortality of acute myeloid leukemia (AML) cases will continue to increase to 184,287.88 and 165,537.59, respectively, by 2040. Using Global Burden of Disease Study (GBD) 2021 data, we assessed the worldwide AL burden from 1990 to 2021, analyzing trends by sex to inform public health strategies.
To delineate the burden of AL, we reported incidence, prevalence, mortality, and disability-adjusted life year (DALY) rates at global, regional, and national levels, with these estimates including age-standardized rates (ASRs) per 100,000 population and average annual percentage changes (AAPCs) from 1990 to 2021 which were stratified by age, sex, and socio-demographic index (SDI), and computed ASRs and AAPCs using linear regression. Temporal trends were analyzed using an age-period-cohort (APC) model with intrinsic estimation (principal component regression). Risk factor attribution quantified contributions of 21 behavioral, environmental, and metabolic exposures to AL-related DALYs. For inequality assessment, we applied the Slope Index of Inequality and Concentration Index to evaluate absolute and relative disparities in AL burden across regions and countries. Future projections (2040) were modeled via a Bayesian APC framework with Integrated Nested Laplace Approximation. All statistical analyses were performed using R software (version R 4.4.1). The GATHER (Guidelines for Accurate and Transparent Health Estimates Reporting) statement provides a framework to ensure the transparency, reproducibility, and quality of health estimates reporting.
Between 1990 and 2021, global ASRs of AL declined, except for acute lymphoblastic leukemia (ALL) age-standardized prevalence rates (ASPR) (AAPC 0.84, 95% CI 0.59-1.10). Case numbers rose overall, though ALL mortality and DALYs decreased. AML burden correlated positively with SDI (ρ > 0, P < 0.001), with the highest number of incident and mortality cases in Western Europe. For ALL, SDI showed positive associations with ASIR and ASPR (ρ > 0, P < 0.001) but negative correlations with ASMR and ASDALR (ρ < 0, P < 0.001), with East Asia being the most severely affected region. High body mass index (BMI), smoking, and benzene/formaldehyde exposure were key AL DALY risk factors. High BMI and smoking predominate in developed countries, and the proportion of DALYs decreases progressively as SDI decreases. Occupational exposures prevailed in developing countries. Population growth drove most absolute increases. Males bore a greater AL burden. AML risk rose with age, whereas ALL displayed bimodal peaks (< 5 and > 40 years). Notably, while ASRs in AL are projected to decline slightly and the number of ALL to decrease by 2040, the number of AML is expected to increase, with the number of incidence and mortality cases increasing by 41.56% and 27.16%, respectively.
As a major public health concern, despite declining ALL-related mortality and DALYs (1990-2021), AL remains a growing global health challenge, with AML cases projected to rise significantly by 2040. Region-specific intervention strategies are required: high-SDI nations should prioritize smoking cessation and metabolic control to address smoking and high BMI-related AML risks while preparing for aging populations, whereas low/middle-SDI countries urgently need enhanced pediatric ALL diagnosis, treatment capacity, and occupational safety measures. Effective mitigation demands evidence-based health planning, including resource allocation guided by projected AL burden trends and targeted policy interventions to reduce healthcare disparities.
尽管在治疗方面取得了进展，但急性白血病（AL）仍然给全球健康带来了沉重负担，其发病率和死亡率一直居高不下。值得注意的是，据预测，到2040年，急性髓系白血病（AML）的发病数和死亡数将分别继续增至184287.88例和165537.59例。我们利用全球疾病负担研究（GBD）2021年的数据，评估了1990年至2021年全球范围内的AL负担，并按性别分析趋势，为公共卫生策略提供依据。
为了描述AL的负担，我们报告了全球、区域和国家层面的发病率、患病率、死亡率和残疾调整生命年（DALY）率，这些估计包括每10万人口的年龄标准化率（ASR）以及1990年至2021年的年均变化百分比（AAPC） ，并按年龄、性别和社会人口指数（SDI）进行分层，使用线性回归计算ASR和AAPC。使用具有内在估计（主成分回归）的年龄-时期-队列（APC）模型分析时间趋势。风险因素归因量化了21种行为、环境和代谢暴露对与AL相关的DALY的贡献。为了进行不平等评估，我们应用不平等斜率指数和集中指数来评估各区域和国家之间AL负担的绝对和相对差异。通过具有集成嵌套拉普拉斯近似的贝叶斯APC框架对未来预测（2040年）进行建模。所有统计分析均使用R软件（版本R 4.4.1）进行。GATHER（准确和透明的健康估计报告指南）声明提供了一个框架，以确保健康估计报告的透明度、可重复性和质量。
在1990年至2021年期间,除急性淋巴细胞白血病（ALL）年龄标准化患病率（ASPR）外，AL的全球ASR有所下降（AAPC 0.84，95%CI 0.59-1.10）。病例数总体上升，不过ALL的死亡率和DALY有所下降。AML负担与SDI呈正相关（ρ＞0，P＜0.001），西欧的发病和死亡病例数最多。对于ALL，SDI与ASIR和ASPR呈正相关（ρ＞0，P＜0.001），但与ASMR和ASDALR呈负相关（ρ＜0，P＜0.001），东亚是受影响最严重的地区。高体重指数（BMI）、吸烟以及苯/甲醛暴露是AL DALY的关键风险因素。高BMI和吸烟在发达国家占主导地位，并且随着SDI的降低，DALY的比例逐渐下降。职业暴露在发展中国家较为普遍。人口增长推动了大多数绝对增长。男性承担了更大的AL负担。AML风险随年龄增长而上升，而ALL呈现双峰（＜5岁和＞40岁）。值得注意的是，虽然预计到2040年AL的ASR将略有下降，ALL的病例数将减少，但AML的病例数预计将增加，发病和死亡病例数将分别增加41.56%和27.16%。
作为一个主要的公共卫生问题，尽管与ALL相关的死亡率和DALY在下降（1990 - 2021年），但AL仍然是一个日益严峻的全球健康挑战，预计到2040年AML病例将显著增加。需要针对特定区域的干预策略：高SDI国家应优先戒烟和控制代谢，以应对与吸烟和高BMI相关的AML风险，同时为老龄化人口做好准备，而中低SDI国家迫切需要加强儿科ALL的诊断、治疗能力以及职业安全措施。有效的缓解措施需要基于证据的健康规划，包括根据预计的AL负担趋势进行资源分配以及有针对性的政策干预，以减少医疗保健差距。
