The Epidemiology of Hematologic Malignancies in East Asia from 1990 to 2021: Estimates from the Global Burden of Disease Study

Introduction: With a population of over 1.6 billion people, the overall cancer burden in East Asia is immense. However, the burden of hematological malignancies (HMs) in East Asia needs to be better understood to allow for more targeted policy and public health efforts.

Methods: Using the Global Burden of Diseases, Injuries, and Risk Factors Study 2021 (GBD 2021), we extracted age-standardized incidence and mortality rates (ASIR and ASMR) and disability adjusted life-years (DALYs) per 100,000 person-years for HMs. Presented are the 2021 and 1990-2021 trend estimates for leukemia, non-Hodgkin lymphoma (NHL), multiple myeloma (MM), and Hodgkin lymphoma (HL) in East Asia and the 6 individual East Asia countries.

Results: In 2021, the burden of HMs globally and in East Asia was driven by China and Japan. China had the highest global HM burden with 238,051 new cases, 117,188 deaths, and 3.9 million DALYs. Japan had 56,702 new cases (#4 globally), 31,907 deaths (#4 globally), and 571,070 DALYs (#7 globally). NHL and leukemia had the most and second most new cases in all countries but North Korea and Mongolia, where they were reversed. NHL and leukemia also had the most and second most deaths and DALYs in Japan, South Korea, and Taiwan but were reversed in China, North Korea, and Mongolia. Males have higher ASIR, ASMR, and DALYs than females in all countries and HMs aside from MM in North Korea.

In 2021, for leukemia, the ASIR, ASMR, DALYs were 7.2, 3.4, 151.6 in China; 5.7, 3.1, 91.6 in Japan; 4.9, 4.1, 187.6 in North Korea; 4.8, 2.4, 82.0 in South Korea; 2.7, 2.4, 108.1 in Mongolia; and 5.2, 3.3, 114.2 in Taiwan, respectively. From 1990 to 2021, all countries had relative decreases in ASIR but Taiwan (+56.1%) and China (+0.98%) with the largest decrease in South Korea (-45.2%). All countries had relative decreases in ASMR and DALYs but Taiwan (+16.3% and +0.25%) with the largest decreases in South Korea (-48.5% and -60.5%).

In 2021, for NHL, the ASIR, ASMR, DALYs were 5.3, 2.1, 67.0 in China; 10.4, 3.6, 84.7 in Japan; 3.1, 2.4, 81.6 in North Korea; 7.1, 2.5, 64.2 in South Korea; 2.1, 1.3, 49.2 in Mongolia; and 7.0, 3.6, 99.4 in Taiwan, respectively. From 1990 to 2021, all countries had relative increases in ASIR but Mongolia (-15.0%) with the largest increase in South Korea (+111.6%). For ASMR, China (-20.2%), South Korea (-4.9%), and Mongolia (-35.3%) had relative decreases while Japan, North Korea, and Taiwan had little to no increase. All countries had relative decreases in DALYs but North Korea (+0.69%) with the largest decrease in Mongolia (-41.6%).

In 2021, for MM, the ASIR, ASMR, DALYs were 0.81, 0.62, 16.1 in China; 2.0, 1.3, 25.7 in Japan; 0.34, 0.29, 8.0 in North Korea; 1.8, 1.2, 24.7 in South Korea; 0.30, 0.28, 8.4 in Mongolia; and 2.0, 1.3, 32.8 in Taiwan, respectively. From 1990 to 2021, all countries had relative increases in ASIR, ASMR, and DALYs but Japan (-8.4%, -20.2%, -28.4%, respectively) and South Korea (0% change in ASMR). For MM, China had the largest relative changes across all diseases and metrics by far with +305% in ASIR, +226% in ASMR, and +221% in DALYs.

In 2021, for HL, the ASIR, ASMR, DALYs were 0.23, 0.13, 4.1 in China; 0.29, 0.07, 2.4 in Japan; 0.34, 0.16, 5.7 in North Korea; 0.21, 0.05, 1.8 in South Korea; 0.59, 0.35, 14.8 in Mongolia; and 0.38, 0.04, 1.7 in Taiwan, respectively. From 1990 to 2021, all countries had relative increases in ASIR but China (-52.1%) and North Korea (0%) with the largest increase in Japan (+70.6%). All countries had relative decreases in ASMR and DALYs with the largest decreases in China (-72.3% and -75.4%).

Conclusions: With the significant contribution to the global burden of HMs from China and Japan, diagnosis and treatment of HMs in these two countries should be a primary global health focus. While the overall ASIR trend from 1990-2021 in most HMs and countries is increasing, the ASMR and DALYs in most are decreasing, perhaps reflective of modern therapeutics improving mortality and morbidity. The notable exception is the significant relative increase of MM ASIR, ASMR, and DALYs across all East Asia countries but Japan; MM is a crucial target of policy and public health efforts, especially in China, where these measures increased substantially by 200-300%. Significant variations between the other East Asia countries also warrant further country- and disease-specific investigations.