Disease burden trends of older adult acute myeloid leukemia (1990-2021): A population-based study

Acute myeloid leukemia (AML) represents a critical hematologic malignancy with profound implications for global public health. Despite advancements in diagnosis and therapy, older patients continue to face poor prognosis, and systematic epidemiological studies focusing on this population remain scarce.

Leveraging the Global Burden of Disease (GBD) 2021 dataset, we applied an integrated analytical framework to conduct a holistic assessment of the AML burden in adults aged ≥60 years from 1990 through 2021. Our approach combined decomposition, frontier efficiency, risk attribution, and predictive modeling.

Incidence, prevalence, mortality, and disability-adjusted life years (DALYs) rates of AML in older adults demonstrated a consistent upward trajectory between 1990 and 2021 and are projected to further intensify by 2050. In 2021, the age-standardized incidence rate (ASIR) was 8.18 per 100,000 (95% uncertainty interval [UI]: 7.04-9.18), age-standardized prevalence rate (ASPR) was 8.31 (95% UI: 7.20-9.28), age-standardized mortality rate (ASMR) was 7.73 (95% UI: 6.64-8.78), and age-standardized DLAY rate (ASDR) was 140.24 (95% UI: 121.14-160.04). ASIR, ASMR, and ASDR increased with age, peaking at 90-94 years, whereas ASPR peaked earlier (80-84 years). Males consistently exhibited higher values across all metrics, with the male-to-female disparity widening progressively with age. Furthermore, ASIR, ASPR, ASMR, and ASDR exhibited a positive association with the Socio-demographic Index (SDI), with high-SDI countries and regions bearing a more severe burden across all metrics. Decomposition analysis identified population growth as the principal contributing factor, while risk-factor attribution indicated smoking, high body-mass index (BMI) and occupational contact with benzene/formaldehyde as the leading modifiable contributors.

This study demonstrates that age-standardized incidence, prevalence, mortality, and DALY rates of older adult AML have followed a persistent ascending trend with distinct demographic and socioeconomic gradients. Specifically, these metrics escalate with age, are consistently elevated in males, and correlate positively with SDI. Smoking, high BMI, and occupational exposures represent key modifiable risk factors. These insights furnish a robust scientific basis for crafting precise prevention and management policies for older adult AML.