Geographic, demographic, and risk factor burden of multiple myeloma in the United States: Insights from the global burden of disease study 2021

Abstract Background: Multiple myeloma (MM) is a plasma cell malignancy with substantial morbidity and mortality. Understanding geographic and demographic patterns, as well as the contribution of modifiable risk factors, is essential for targeted prevention and optimized care delivery. This study evaluates the U.S. burden of MM using the Global Burden of Disease (GBD) 2021 dataset, with emphasis on age-standardized disability-adjusted life years (DALYs) attributable to high body mass index (BMI) and temporal trends assessed by Estimated Annual Percentage Change (EAPC). Methods: Data were extracted from the Institute for Health Metrics and Evaluation (IHME) GBD 2021 Results Tool. Age-standardized incidence, prevalence, death, and DALY rates were analyzed by state, sex, and age group. Age-standardized DALYs attributable to high BMI were calculated for both sexes and by state. EAPCs with 95% confidence intervals (CIs) were computed for incidence, prevalence, mortality, and DALY rates to assess temporal trends. Descriptive statistics were performed using Microsoft Excel. Results: The highest age-standardized incidence rates occurred in Louisiana (4.23), District of Columbia (3.80), and Georgia (3.58), while the lowest were in Hawaii (1.95), Connecticut (2.35), and New York (2.41). Prevalence was highest in Louisiana (9.77), New Jersey (9.18), and Georgia (7.21), and lowest in Hawaii (2.94), Connecticut (3.45), and New Mexico (3.48). Death rates peaked in the District of Columbia (3.77), Louisiana (3.57), and South Carolina (3.57). DALY rates were highest in the District of Columbia (84.34), Louisiana (75.56), and Alabama (75.32). High BMI was the only modifiable risk factor analyzed, with an age-standardized DALY rate of 8.43 in males, 5.32 in females, and 6.76 overall, indicating a greater burden in males. The percentage of DALYs attributable to high BMI was highest overall in West Virginia (12.74%), Mississippi (12.54%), and Louisiana (12.40%), and lowest in Hawaii (10.21%), Colorado (10.49%), and California (10.89%). Male predominance in BMI-related DALY burden was seen in states such as Iowa, North Dakota, and Alaska, while female predominance was noted in states including Mississippi, Louisiana, and Georgia. Age-specific analysis showed that incidence, prevalence, death, and DALY rates increased progressively from ages 15–39 to 75–84 years, then declined in those aged ≥85 years. The highest crude prevalence was in ages 75–84 years (42.7 per 100,000) and 65–74 years (31.17 per 100,000). Death and DALY numbers peaked in the 65–74 age group for both sexes, with male predominance except in those ≥85 years. EAPC analysis revealed that MM age-standardized incidence rates declined slightly (–0.46%, 95% CI: –0.61 to –0.32), death rates decreased (–0.68%, 95% CI: –0.80 to –0.57), and DALY rates declined more sharply (–1.05%, 95% CI: –1.17 to –0.93). Prevalence rates showed a modest but non-significant increase (0.12%, 95% CI: –0.16 to 0.40).Conclusion: This analysis demonstrates substantial geographic and demographic variation in MM burden across the United States. Southern states, particularly Louisiana, Mississippi, and Alabama, have disproportionately high incidence, prevalence, mortality, and DALY rates. High BMI is a major modifiable risk factor, contributing more than 12% of DALYs in certain states, with male predominance in most regions. Temporal trends suggest modest declines in incidence, mortality, and DALY rates, but a stable prevalence, likely reflecting improved survival. Targeted interventions—particularly obesity prevention and weight management programs in high-burden states—alongside early detection and equitable treatment access are needed to reduce MM burden nationwide.