Long-term trends in mortality of leukemia in Asia from 1992 to 2021

Leukemia represents a substantial health burden globally, yet comprehensive studies of long-term mortality trends specific to Asia remain limited. Data from the Global Burden of Disease Study (GBD) 2021 for 1992 to 2021 were used to evaluate leukemia mortality across 34 Asian countries and 5 Global Burden of Disease Study subregions. The age-period-cohort (APC) model examined age, period, and cohort effects on mortality rates. Decomposition analysis quantified contributions of population aging, growth, and epidemiological changes. From 1992 to 2021, leukemia deaths in Asia increased by 18.81%, from 136,446 (95% UI: 111,167-157,844) to 162,117 (95% UI: 131,232-188,521), while age-standardized mortality rate (ASMR) declined from 4.96 (95% UI: 4.08-5.69) to 3.39 (95% UI: 2.74-3.94) per 100,000 (net drift: -1.25%, 95% CI: -1.35 to -1.15). High-income Asia Pacific showed the largest ASMR decline (net drift: -1.98%, 95% CI: -2.11 to -1.85), while Southeast Asia had the highest ASMR (4.33, 95% UI: 3.56-5.20). Acute myeloid leukemia led deaths in most subregions, except East Asia, where acute lymphoblastic leukemia predominated (34.60%). Population aging (25.46%) and growth (37.78%) drove mortality increases, while epidemiological changes reduced mortality by 44.43%. Age-period-cohort analysis revealed a U-shaped age effect, with mortality peaking in early childhood (0-4 years: 6.22 [95% CI: 5.86-6.61] per 100 000) and older adults (90-94 years: 21.93 [95% CI: 19.85-24.22] per 100,000). Period effects showed a consistent decline, most notably in High-income Asia Pacific and East Asia. Cohort effects indicated reduced mortality risks in later birth cohorts, particularly in East Asia. Although leukemia ASMR declined substantially across Asia from 1992 to 2021, the absolute number of deaths increased because of population growth and aging. Southeast Asia, where ASMR remained highest, requires strengthened diagnostic and referral systems and improved access to essential leukemia therapies. In East Asia, the predominance of ALL-related deaths warrants further investigation and broader implementation of risk-stratified ALL treatment protocols. Across Asia, leukemia control should prioritize children, older adults, subtype-specific surveillance, pediatric hematology services, and geriatric oncology care to reduce persistent regional disparities.