Global and Regional Burden of Multiple Myeloma from 1980 to 2021: An Analysis of Gbd Study 2021

Background: Multiple myeloma (MM) is a hematologic malignancy characterized by the abnormal increase of monoclonal immunoglobulins. While the advent of novel targeted therapies and transplantation techniques has led to an improvement in five-year overall survival rates, it still carries a high risk of morbidity and mortality. Previous epidemiological studies have reported significant regional disparities in MM incidence and mortality rates. Here we aim to assess the global burden of MM and evaluate and explain regional disparities, if any.

Methods: This study utilized data from the Global Burden of Diseases (GBD) database to examine multiple myeloma metrics, including age-standardized death rates (ASDR), Years of Lost Life (YLL), and disability-adjusted life years (DALYs) from 1980 to 2021. The data were stratified by continent, subcontinental regions, socio-demographic index (SDI), and World Bank income groups. We applied Joinpoint Regression to determine trends and average annual percentage changes (AAPC) over the study period.

Results: The global age-standardized death rates (ASDR) due to MM showed a steady increasing trend from 1980 to 2021. In 1980, the ASDR was 1.18 (95% UI 1.08-1.27), which increased to 1.37 (AAPC=0.40; 95% CI 0.38-0.42) by 2021. More specifically, there were significant changes in the ASDR from 1985 to 1992 with an annual percentage change (APC) of 0.81 (95% CI 0.46-0.91). The global disability-adjusted life years (DALYs) rate for MM increased from 28.33 (95% UI 26.33-30.83) in 1990 to 30.00 (AAPC=0.18; 95% CI 0.16-0.21) in 2021. Additionally, the age-standardized years of life lost (YLL) due to MM increased from 25.85 (95% UI 23.74-28.19) in 1980 to 29.04 in 2021 (AAPC=0.28; 95% CI 0.27-0.30). In the continent-wise analysis, North America exhibited the highest ASDRs but a declining trend in the studied period (AAPC=-0.004, 95% CI -0.023 to -0.016). Trends in Europe varied during different times, with an overall AAPC showing slight increase from 1980 to 2021 (AAPC=0.69, 95% CI 0.65-0.72). Asia had the lowest ASDRs among the four continents but experienced the highest rate of increase from 1980 to 2021 (AAPC=1.47, 95% CI 1.44-1.50). Africa also experienced a steady and uniform overall increase in ASDRs throughout the study period (AAPC=1.07, 95% CI 1.05-1.08). Among the various US census regions, Southern part of the US had the highest ASDRs while Western regions had the lowest. High-income level countries and higher SDI regions had higher ASDRs than low-income countries and lower SDI regions

Conclusion: Multiple myeloma is associated with significant mortality and reduced quality of life, making it a pressing public health concern. From 1980 to 2021, ASDRs exhibited a steady increase across continents. America had the highest ASDRs possibly due to better diagnostic capacity. In contrast, Asia demonstrated the most pronounced rise in multiple myeloma related mortality, which may be attributable in part to the increased life expectancy and rise in the aging population.