The epidemiological landscape of multiple myeloma: a global cancer registry estimate of disease burden, risk factors and temporal trends

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Background

Multiple myeloma accounted for 176,404 (14%) of the 1,278,362 incidence cases of leukemia, lymphoma and multiple myeloma in 2020. Identifying its geographic distribution, risk factors and epidemiological trends could help identify high-risk population groups. Our objective was to examine the worldwide incidence, mortality, associated risk factors, and temporal trends of multiple myeloma by sex, age, and geographic region.

Methods

Incidence and mortality of multiple myeloma were extracted from Global Cancer Observatory (2020), Cancer Incidence on Five Continents, WHO Mortality Database, Nordic Registries of cancer and the surveillance, epidemiology and end results program (1980-2019). The WHO Global Health Observatory data repository was consulted for age-standardized prevalence of lifestyle and metabolic risk factors (2010). Associations with risk factors were examined by multivariate regression. Temporal trends were assessed by average annual percent change (AAPC) using joinpoint regression.

Results

The age-standardized rate (ASR) of multiple myeloma incidence was 1 78 (95% IU 1 69–1 87) per 100,000 people worldwide, and mortality was 1 14 ( 95% IU 1 07–1 21 ) per 100,000 people worldwide in 2020. Increased incidence and mortality were associated with human development index, gross domestic product, prevalence of physical inactivity, overweight, obesity and diabetes. Australia and New Zealand (ASR 4 86 [4·66–5·07]), North America (4 74 [4·69–4·79]), and Northern Europe (3 82 [3·71–3·93]) reported the highest incidence. The lowest incidences were observed in West Africa (0.81
[0·39–1·66]), Melanesia (0 87 [0·55–1·37]) and Southeast Asia (0 96 [0·73–1·27]). Overall, more countries have seen an increase in incidence, particularly among men aged 50 or older. The countries with the highest increase in incidence among men over 50 are Germany (AAPC 6 71 [95% CI 0·75–13·02] p=0 027), Denmark (3 93 [2·44–5·45] p=0 00027), and South Korea (3 25 [0·69–5·88] p=0 019). For women aged 50 or over, Faroe Islands (21 01 [2·15–43·34] p=0 032), Denmark (4 70 [1·68–7·82]p=0 0068), and Israel (2 57 [0·74–4·43] p=0 012) reported the largest increases. Overall, there was a downward trend for multiple myeloma mortality. The highest mortality was observed in Polynesia (ASR 2 69 [0·74–9·81]), followed by Australia and New Zealand (1 84 [1·73–1·96]) and Northern Europe (1 80 [1·73–1·88]). The lowest mortalities were reported in Southeast Asia (ASR 0 82 [0·62–1·09]), East Asia (0 76 [0·71–0·81]) and Melanesia (0.73
[0·61–0·87]). Men (1 41 [1·29–1·53]) had higher mortality than women (0.93 [0·85–1·02]).

Interpretation

There was an upward trend in the incidence of multiple myeloma worldwide, particularly among men, people aged 50 or older, and those in high-income countries. The overall global downward trend in mortality from multiple myeloma was most evident in women. Lifestyle habits, diagnostic capacity and availability of treatments need to be improved to control the increasing trends of multiple myeloma in high-risk populations. Future studies should explore the reasons for these epidemiological transitions.

Funding

None.

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