The burden of hematological malignancies in Latin America and the Caribbean: A 30-year global burden of disease analysis

Abstract

Abstract Background Hematologic malignancies (HM) such as leukemia, non-Hodgkin lymphoma (NHL), Hodgkin lymphoma (HL), multiple myeloma (MM), and myeloproliferative neoplasms (MPN), rank among the leading cancer-related causes of death. However, their burden in Latin America and the Caribbean (LAC) with great ethnic, social, cultural and biological diversity remains undercharacterized. This study aimed to characterize health burden trends of HM in LAC. Methods We analyzed the Global Burden of Disease 2021 study data to estimate age-standardized rates for incidence (ASIR), mortality (ASMR) and DALYs (ASDALYR) per 100,000 person-years for HMs in LAC between 1990 to 2021, and change in each measure is presented as relative percentage change. We included thirty-three countries from the LAC region per the World Bank definition. Data was analyzed by disease, sex, region, and country. The association between Socio-Demographic Index (SDI)—a composite measure of income, education and fertility—and HM burden was assessed using linear regression. Results In LAC, leukemia ASIR remained stable (-5.2%, 95%UI -12 to 3). Chronic myeloid leukemia (CML) had the largest ASIR drop (-49%, 95%UI -54 to -42), and acute myeloid leukemia (AML) ASIR rose the most (9%, 95%UI 7-17). Leukemia ASMR fell (-15%, 95%UI -21 to -8), driven by CML (-56%, 95%UI -60 to -51). ASDALYR declined by 22% (95%UI -29 to -14), due to CML (-60.3%, 95%UI -64.3 to -55.4). Burden decreased most in Southern Latin America (ASIR -14% (95%UI -20 to -8), ASMR -26% (95%UI -31 to -21), ASDALYR -33% (95%UI -37 to -28)). In 2021, ASIR, ASMR, and ASDALYR were highest in Costa Rica, Bolivia, and Haiti, respectively. In LAC, NHL ASIR increased 47% (95%UI 34-61), with the largest increase in Andean Latin America (169% 95%UI 105-241). ASMR was stable in LAC but increased in Central Latin America (15%, 95%UI 3-28) and decreased in the Caribbean (-18%, 95%UI -28 to -8). ASDALYR dropped 10% (95%UI -17 to -3) with the largest decline in Southern Latin America (-25%, 95%UI -30 to -18). In 2021, ASIR was highest in Peru while ASMR and ASDALYR were highest in Grenada. In LAC, HL ASIR declined 18% (95%UI -24 to -10), ASMR decreased -47% (95%UI -52 to -43), and ASDALYR dropped -48% (95%UI -52 to -44). The Caribbean had the largest ASIR drop (-27%, 95%UI -40 to -12); Southern Latin America led in ASMR (-54%, 95%UI -64 to -42) and ASDALYR (-52%, 95%UI -63 to -38) reductions. In 2021, ASIR was highest in Cuba; ASMR and ASDALYR in Grenada. In LAC, MM ASIR increased by 34% (95%UI 26-44). ASMR and ASDALYR increased by 19% (95%UI 12-28) and 19% (95%UI 11-27), respectively. Across all measures, Tropical Latin America had the highest increase in burden (ASIR 62% (95%UI 53-70), ASMR 47% (95%UI 40-52), ASDALYR 39% (95%UI 33-45)). Across all measures, The Bahamas had the highest rates in 2021. In LAC, MPN burden grew: 39% (95%UI 34-46) for ASIR, 80% (95%UI 42-115) for ASMR, and 59% (95%UI 27-88) for ASDALYR. Tropical Latin America had the largest increase in burden (ASIR 206% (95%UI 174-248), ASMR 114% (95%UI 76-145), ASDALYR 95% (95%UI 60-124)). In 2021, ASIR was highest in Chile, ASMR was highest in Bermuda, and ASDALYR was highest in Venezuela. Across all subtypes, males consistently experienced higher ASIR, ASMR, and ASDALYR. Linear regressions showed significant associations: higher SDI correlated with increased MM ASIR (Coef = 12.1, R²=0.6, p<0.0001), ASMR (Coef = 7, R²=0.5, p<0.0001) and ASDALYR (Coef = 164.9, R²=0.47, p<0.0001). Higher SDI was also associated with lower ALL ASIR (Coef = -2.9, R²=0.17, p = 0.01), ASMR (Coef = -3.78, R²=0.3, p = 0.0003), and ASDALYR (Coef = -222, R²=0.38, p<0.0001). Positive associations were seen with CLL ASIR (Coef = 2.27, R²=0.2, p = 0.004), NHL ASIR (Coef = 18, R²=0.12, p = 0.03) and MPN ASMR (Coef = 1.82, R²=0.18, p = 0.009). Conclusions Over the past 30 years, HM in LAC showed rising ASIR for NHL, MM, and MPN. HL burden declined across all metrics. Leukemia outcomes improved, especially in CML. In contrast, MM and MPN increased across all metrics, likely reflecting improved diagnosis but limited access to advanced treatments. The Caribbean had the highest HM burden in 2021. Over time, Tropical Latin America had the greatest increase while Southern Latin America had the greatest decrease. Strong SDI-outcome associations reinforce the role of socioeconomic development. These findings underscore the need for targeted, region-specific policies to curb the growing HM burden in LAC.