Exploring the Burden of Acute Myeloid Leukemia Attributable to Smoking in G20 Countries: A Three-Decade Analysis from the Gbd 2021

Introduction: Acute Myeloid Leukemia (AML) represents the most prevalent cause of death among all leukemia types within the G20 countries. Among various modifiable risk factors, smoking emerges as a significant attributable risk. The G20 nations, which encompass the world's largest economies, play a pivotal role in global health governance and interventions. This study aims to estimate the burden of AML attributable to smoking across these countries, providing crucial insights that are in alignment with the G20's health commitments. Method: Using global burden of disease 2021 standardized methodologies, we estimated deaths, disability-adjusted life years (DALYs), years lived with disability (YLDs), years of life lost (YLLs) by age, sex, year and location across the G20 countries due to AML attributable to smoking. Fatal health outcome was estimated using the cause of death ensemble model (CODEm). Results: From 1990 to 2021, the total number of deaths attributable to smoking-related AML increased from 7,127 (95% uncertainty interval: 2,681-11,531) to 13,020 (4,471-22,708). During the same period, DALYs rose from 169,194 (65,482-271,499) to 262,928 (94,709-448,953), and YLDs increased from 2,005 (702-3,572) to 3,780 (1,242-7,114). The annual percentage change (APC) in age-standardized mortality rates (ASMR) saw the highest increase in Lithuania at 3.29%, followed by Estonia at 2.65%. Conversely, the most significant decrease was observed in South Africa at -2.41% and in the United States, which observed a decline of 44% from 1990-2021. In 2021, the highest ASMR was recorded in Greece at 0.7 (0.27-1.14) cases per 100,000 person-years, followed by the USA at 0.6 (0.19-1.08) cases, and Denmark at 0.54 (0.19-0.95) cases. Regarding the YLDs rate, the highest was observed in the USA at 0.2 (0.06-0.37) per 100,000 in 2021. Age analysis revealed that individuals older than 70 years experienced 8,678 (2,845-15,523) deaths, while those under 70 years accounted for 4,342 (1,657-7,126) in 2021. The DALYs for age groups 20-54 years were 28,263 (10,952-46,606), for 50-69 years were 114,894 (43,840-189,425), and for those over 70 years, it was 132,333 (43,867-233,700). In terms of gender, the overall burden was observed to increase more in males compared to females, with the total percentage change in deaths for males vs. females being 92% vs. 54%, in DALYs 63% vs. 30%, and in YLDs 97% vs. 64% from 1990 to 2021. Conclusion: In 2021, deaths from AML attributable to smoking constituted 13.42% of all AML-related fatalities in G20 countries. Despite advancements in treatment, the burden continues to escalate. From a public health perspective, it is imperative to engage social media influencers and celebrities in preventative strategies to combat this growing issue. This approach aims to foster an environment conducive to adopting healthier lifestyles. Although the dangers of smoking are well-known, the prevailing environment often supports its use. Given that smoking is a significant risk factor for neoplastic diseases, there is a crucial need for enhancements in AML management from a clinical standpoint.