The global and regional burden of leukemia from 1990-2023: A systematic analysis for the Global Burden of Disease study 2023.

e18625 Background: Leukemia represents an important component of global hematologic malignancy burden across the age spectrum, particularly for children and adolescents. While advancements in diagnostics and treatment have the potential to reduce the global burden from leukemia, it remains unclear how effective these gains have been distributed across all regions. This study aims to analyze leukemia incidence and mortality from 1990-2023 globally as well as by World Bank income group, age group, and leukemia type. Methods: Data from population-based cancer registries and vital registration systems were used to generate ensemble models for mortality counts and age-standardized rates for leukemia and five leukemia types: acute lymphoid leukemia (ALL), acute myeloid leukemia (AML), chronic lymphoid leukemia (CLL), chronic myeloid leukemia (CML), and other leukemias. Matched incidence and mortality data were used to generate modeled mortality to incidence ratios, which were subsequently applied to mortality estimates to generate incidence. Results: Leukemia was the ninth most common cancer globally in 2023 among all ages with 582,000 (450,000 to 745,000) incident cases and 342,000 (307,000 to 382,000) deaths. Among 0-19 year-olds, there were 98,600 (68,000-139,000) incident cases and 45,900 (38,700 to 56,200) deaths globally, making it the most common cancer in children. Globally, AML was the most common leukemia subtype among all ages in 2023 while ALL was greatest among children aged 0-19 years. Between 1990 and 2023, global leukemia all-age age-standardized mortality rates (ASMR) decreased by 33.2% (24.2 to 41.0) from 5.9 (5.3 to 6.5) to 4.0 (3.6 to 4.4) per 100,000 while all-age age-standardized incidence rates (ASIR) changed by -21.4% (-41.8 to 10.7) from 8.7 (7.3 to 10.6) to 6.8 (5.2 to 8.8) per 100,000. The global 2023 0-19 ASIR was 3.8 (2.6 to 5.4) per 100,000 and the ASMR was 1.7 (1.5 to 2.1). Reductions in ASMRs between 1990 and 2023 were most pronounced in upper middle income and high income countries, -40.3 (-47.8 to –28.1) and –29.3 (-33.5 to –24.8), respectively, compared to the changes seen in lower middle income and low income countries, -18.8 (-41.8 to 10.7) and –19.5 (-43.6 to 16.0), respectively. Conclusions: Estimates from GBD 2023 demonstrate that leukemia remains the most common childhood cancer with leukemia type patterns varying across adults and children. Although ASMRs are declining globally, there have been more substantial declines in higher income countries compared to lower income countries, calling attention to inequities. These age and geographic patterns underscore the importance of targeted approaches to reducing the burden of leukemia and increased efforts to expand access to effective diagnostic and treatment services in lower resourced settings.