Epidemiology of acute myeloid leukemia in children and adolescents (1990–2021): a global burden of disease study

Acute myeloid leukemia (AML) remains a significant global health concern in children, though its epidemiological landscape has markedly changed over recent decades. Understanding these evolving trends can guide targeted healthcare strategies and resource allocation. Utilizing data from the Global Burden of Disease (GBD) database spanning 1990-2021, we analyzed global, regional, and national trends in AML incidence, mortality, and disability-adjusted life years (DALYs) among children and adolescents. We applied annual percentage change (APC), estimated annual percentage change (EAPC), and correlations with the socio-demographic index (SDI) to quantify trends and influencing factors. From 1990 to 2021, global childhood AML incidence decreased by 37%, with mortality and DALYs declining by 40% and 42%, respectively. The most pronounced reductions occurred in children under 5 years of age. Substantial disparities emerged across SDI regions, with the high-middle SDI group exhibiting the sharpest declines in incidence (EAPC = - 2.96%), mortality (-3.44%), and DALYs (-3.51%). In contrast, the low SDI region saw mortality rise by 8% and DALYs increase by 5%. South Asia carried the highest absolute disease burden, while Oceania recorded the highest population-adjusted rates. Nationally, China reported the greatest incidence and India the highest mortality, despite both countries achieving significant reductions. Despite aggregate gains, childhood AML burden remains concentrated in lower-SDI settings, where exposure-related attribution is rising and outcome improvements lag. Prioritizing prevention, earlier diagnosis, and equitable access to definitive care is essential to narrow these disparities and accelerate global progress.