Global, Regional, and National Burden of Chronic Myeloid Leukemia Among the Elderly from 1990 to 2021: A Population-Based Epidemiological Analysis

Purpose: This study aimed to evaluate the global, regional, and national burden of chronic myeloid leukemia (CML) in the elderly population from 1990 to 2021, analyzing trends in prevalence, mortality, disability-adjusted life years (DALYs), associated risk factors, and disparities across sociodemographic strata. Methods: Based on data from the Global Burden of Disease (GBD) 2021 study, we analyzed age-standardized rates for CML in adults aged ≥ 65 years across 204 countries and territories. Trends were quantified using the average annual percentage change (AAPC), and burden estimates were stratified by age, sex, region, and sociodemographic index (SDI). Results: From 1990 to 2021, the global age-standardized prevalence of CML among the elderly declined from 5.80 to 3.37 per 100,000 population (AAPC: − 1.71%). Age-standardized mortality decreased from 4.22 to 1.78 per 100,000 (AAPC: − 2.73%), and DALYs fell from 68.05 to 27.57 per 100,000 (AAPC: − 2.86%). Declines in DALYs were most pronounced in the 65– 69 years subgroup (− 3.33% per year). Mortality reductions were greater in high-SDI countries (− 3.67% per year) than in low-middle-SDI countries (− 0.66% per year). In 2021, the highest prevalence was observed in High-income North America and Western Europe, while the highest DALY rates were identified in Oceania, the Caribbean, North Africa, and the Middle East. Smoking remained the leading modifiable risk factor, contributing to 3.93 DALYs per 100,000 in 2021. Conclusion: Over the past three decades, significant improvements in survival and reductions in disease burden have been achieved for elderly CML patients globally, attributable to therapeutic advances. However, substantial disparities persist across sexes and SDI levels. These findings highlight the need for targeted health strategies, equitable access to care, and age-specific guidelines to address the growing burden of CML in aging populations. Keywords: chronic myeloid leukemia, global burden of disease, elderly, prevalence, mortality, disability-adjusted life years, epidemiology