Epidemiological Trends in Incidence, Death and Associated Risk Factors of Multiple Myeloma 1990-2021 and Projection to 2040

Introduction:

Multiple Myeloma (MM) constitutes about 1.8% of all newly diagnosed cancer cases and 2% of deaths related to cancer in 2024 in the US. We aim to investigate the epidemiological trends (incidence and death rates) and predictive factors of MM at global and regional level.

Methods:

The study analyzed data from 1990 to 2021, obtained from the Global Health Data Exchange 2021 database which is a comprehensive catalog of global health and demographic data, providing access to a wide range of datasets around the world. This study described the age-standardized rates (per 100,000 patient- years) of incidence (ASIR), death (ASDR) and attributable risk factors of MM. Although the strength of the association has not been validated. Regions were stratified by Sociodemographic Index (SDI) ranged from 0 (minimal development) to 1 (maximal development) and was classified as high (>0.715), high-middle (0.625 to .0715), middle (0.558 to 0.624), low-middle (0.378 to .0557), and low (<0.378) SDI regions. Geographic locations were defined based on World Bank (WB) regions (South Asia, East Asia & Pacific, Europe & Central Asia, North America, Latin America & Caribbean, Middle East & North Africa, Sub-Saharan Africa). We used autoregressive model on the training set up till year 2021 and that model is used for prediction till 2040.

Results:

In 2021, global number of cases and deaths of MM were 82,454 and 63,122 for males(M) and 66,301 and 53,238 for females(F). The global ASIR were 2.12 for males and 1.43 for females, while the ASDR were 1.67 for males and 1.14 for females. From 1990 to 2021, both ASDR (0.11) and ASIR (0.25) increased for males, while for females, ASIR increased (0.10) but ASDR remained stable (0.00).

High BMI was identified in the dataset as the risk factor for deaths in MM, contributing to 8.46% of age-standardized deaths (ASD) in females and 7.33% in males globally in 2021, although strength of the association has not been validated in the dataset. From 1990 to 2021, the ASD associated with high BMI increased by >20 % (Annual Percentage Change (APC): M:23.86%, F: 27.44%).

Divided by SDI Regions: In 2021, the highest ASIR and ASDR for both sexes were observed in the High SDI region (ASIR: M:3.99, F: 2.47; ASDR: M: 2.87, F: 1.82), followed by High-middle, Middle, Low-middle, and Low SDI regions, with males showing higher ASDR and ASIR than females. From 1990 to 2021, the ASDR increased in all SDI regions except High SDI where it decreased (APC: M: -0.08, F: -0.13). The ASIR increased in all SDI regions except for females in High SDI (APC: F: -0.01). Males showed higher increases in ASIR and ASDR for most SDI regions except Low SDI (APC of ASIR: M: 0.33, F: 0.41; ASDR: M: 0.29, F: 0.37).

In 2021, the highest percentage of ASD related to high BMI was recorded in High-middle SDI regions for females (9.74%) and High SDI regions for males (8.87%). From 1990 to 2021, high BMI related ASD nearly doubled for males in Low SDI (105.38%) and Low-middle SDI (97.67%) regions, and were highest for females in Low-middle SDI (68.89%) and Low SDI (60.45%).

Divided by World Bank Regions: In 2021, Europe & Central Asia had the highest ASIR of MM for both sexes (M: 4.11, F: 2.61) and North America had the highest ASDR for both sexes (M:3.58, F; 2.20). Overall, males tend to have higher ASDR and ASIR compared to females across most regions, except for Sub-Saharan Africa where females had higher ASIR and ASDR. From 1990 to 2021, the ASDR increased in all regions except for North America (APC: M: -0.12, F: -0.18). The highest increase in ASDR was seen in South Asia for males (0.70) and Sub-Saharan Africa for females (0.49).

In 2021, females had a higher percentage of ASD due to high BMI across all WB regions compared to males. The highest percentage of ASD was seen in North America for males (10.93%) and in the Middle East & North Africa for females (11.75%). From 1990 to 2021, high BMI related ASD more than doubled in South Asia (M: 120.86%, F: 114.45%).

Our analysis predicts that the incidence and death rate of MM will increase till 2040 for both the sexes.

Conclusion:

From 1990 to 2021, although the global ASIR increased for both genders, ASDR increased in males but stable in females. High BMI was identified as a risk factor contributing to MM deaths. From 1990 to 2021, high BMI related ASD nearly doubled for males in lower SDI regions and in South Asia. The findings highlight significant gender and regional disparities in the incidence and mortality of multiple myeloma.