Trends and burden of retinoblastoma incidence, prevalence, and mortality in the United States, 1990–2023: A retrospective analysis with machine learning projections to 2050.

Abstract

e22609 Background: Retinoblastoma, a rare intraocular malignancy primarily affecting children, has seen declining age-standardized burden in high-income settings due to improved early detection, treatment, and survival. This study examined trends in age-standardized DALYs, deaths, incidence, and prevalence among US adults (≥20 years) from 1990 to 2023 using IHME GBD 2023 data, calculated estimated annual percentage changes (EAPC), and projected future rates to 2050 via ARIMA forecasting. Methods: Age-standardized rates (ASRs) per 100,000 population were extracted from the Global Burden of Disease 2023 database for the United States, stratified by sex (Both, Female, Male). Historical trends (1990–2023) were quantified using EAPC from linear regression on log-transformed ASRs. Future projections (2024–2050) utilized ARIMA models fitted to historical time series, producing point estimates and 95% prediction intervals (PI). Results: From 1990 to 2023, age-standardized DALYs (Both sexes) declined markedly from 0.823 (95% UI: 0.665–1.012) to 0.391 (95% UI: 0.263–0.571), yielding an EAPC of -2.35% (95% CI: -3.08 to -1.63); females exhibited a steeper decline (EAPC -2.91%, 95% CI: -3.77 to -2.04) than males (EAPC -1.92%, 95% CI: -2.55 to -1.27). Age-standardized death rates fell from ~0.0088 to ~0.0041 (EAPC -2.47%, 95% CI: -3.22 to -1.71), with stronger reductions in females (EAPC -3.02%) than males (EAPC -2.03%). Incidence decreased from 0.106 to 0.078 (EAPC -1.19%, 95% CI: -1.74 to -0.64), and prevalence from 0.972 to 0.683 (EAPC -1.23%, 95% CI: -1.75 to -0.70), reflecting improved survival and reduced new cases in adults. ARIMA forecasts indicate continued substantial declines in age-standardized DALYs (Both: from 0.372 in 2024 toward near-zero values by 2050), deaths (approaching zero by mid-century), incidence (stabilizing near 0.074 then trending downward), and prevalence (gradual erosion to low levels by 2050), driven by historical momentum and near-elimination of adult-onset cases. Conclusions: Age-standardized burden of retinoblastoma in US adults declined sharply from 1990–2023 across all metrics, with the steepest reductions in DALYs and mortality, particularly among females. Projections to 2050 suggest near-eradication of age-standardized impact in adults, underscoring the success of pediatric retinoblastoma management and the rarity of adult presentations in high-resource settings. Measure Sex EAPC Lower 95%CI Upper 95%CI DALYs Both -2.35 -3.08 -1.63 DALYs Female -2.91 -3.77 -2.04 DALYs Male -1.92 -2.55 -1.27 Deaths Both -2.47 -3.22 -1.71 Deaths Female -3.02 -3.9 -2.12 Deaths Male -2.03 -2.7 -1.36 Incidence Both -1.19 -1.74 -0.64 Incidence Female -1.75 -2.44 -1.05 Incidence Male -0.76 -1.24 -0.27 Prevalence Both -1.23 -1.75 -0.7 Prevalence Female -1.77 -2.44 -1.09 Prevalence Male -0.81 -1.26 -0.36