The Burden of Myelodysplastic Syndromes and Myeloproliferative Neoplasms From 1990 to 2023, Among the GBD Super Regions, the GBD Regions and the Socio-Demographic Index Quintile Countries: Results From the Global Burden of Disease Study 2023.
In late 2025, the Institute for Health Metrics and Evaluation (IHME) at the University of Washington–Seattle released the estimates from the Global Burden of Disease Study 2023 (GBD 2023). We now report the time trends in myelodysplastic syndromes and myeloproliferative neoplasms (MDS/MPN) burden from 1990 to 2023, across GBD Super Regions, GBD Regions, and countries stratified by the Socio-Demographic index (SDI), according to the 2016 revision to the World Health Organization (WHO) classification of myeloid neoplasms and acute leukemia [1]. The GBD framework classifies all countries into seven Super Regions—High-Income; Latin America and Caribbean; Sub-Saharan Africa; North Africa and Middle East; South Asia; Southeast Asia, East Asia, and Oceania; and Central Europe, Eastern Europe, and Central Asia—based on epidemiological similarity, cause-of-death patterns, and geographic proximity. These Super Regions are further subdivided into 21 GBD Regions [2]. The SDI is a composite measure of national development status, calculated as the geometric mean of scaled values for total fertility rate among females under 25, average years of education for individuals aged 15 and older, and lag-distributed income per capita [3]. Countries are grouped into five SDI quintiles: Low, Low-middle, Middle, High-middle, and High. These classifications capture heterogeneity in population structures, governance, and healthcare systems. For reference, other international organizations use different regional classifications—for example, the six WHO regions, the seven World Bank regions, and the World Bank income-based groupings [4, 5]. The burden of MDS/MPN was assessed using age-standardized rates for incidence (ASIR), mortality (ASMR), and disability-adjusted life years (DALYs) (ASDR) in 1990 and 2023, along with their annual percent changes (APCs). DALYs are defined as the sum of years lived with disability (YLDs) and years of life lost (YLLs). Rates were reported per 100 000 person-years and standardized using the GBD global reference population, accounting for changes in population size and age structure. All estimates include 95% uncertainty intervals (UIs), and differences were considered statistically significant when the 95% UIs did not overlap. MDS/MPN-related survival was approximated using the age-standardized mortality-to-incidence ratio (ASMIR), derived from point estimates of ASIR and ASMR for 1990 and 2023. The methodology underlying GBD estimates has been detailed elsewhere [6-9]. Across the seven GBD Super Regions, none of them recorded a decline in ASIR, ASMR, and ASDR (Table 1). In particular, ASIR and ASMR significantly increased everywhere, except for Sub-Saharan Africa, where both were stable over time; similarly, ASDR worsened in five Super Regions, except for Sub-Saharan Africa and South Asia, with unchanged estimates. Central Europe, Eastern Europe, and Central Asia recorded the most severe boost in the three metrics; on the other side, MDS/MPN occurred very rarely among Sub-Saharan Africa countries. ASMIR markedly worsened across all GBD Super Regions, including High-Income countries too: its value widely ranged from 6.3 to 36.8 in 1990, from 9.5 to 60.7 in 2023. The worst performance for ASMIR in 2023 occurred in South Asia: being almost stable the incidence rate, that for mortality doubled along the study period. Among SDI quintiles, none of them showed improvements in ASIR, ASMR, and ASDR. As for incidence, its age-standardized rate over time increased in three quintiles (except the Low and Low-middle SDI), while those for mortality and DALYs among four ones, except only the Low SDI quintile (Table 2). Of note, a linear relationship linked the SDI quintiles to the increase of the three age-standardized rates, as already discovered for the other oncohematological neoplasms. As happened among Super Regions, ASMIR considerably rose, doubling across the first four SDI quintiles, except the High one; it ranged from 10.3 to 23.1 in 1990, from 17.0 to 40.7 in 2023. Disaggregating the 7 Super Regions into the 21 GBD Regions, ASIR significantly rose in fifteen Regions (across all Super Regions, with the most severe trajectory in the High-Income Asia Pacific Region), was stable in other five, and improved only in Western Sub-Saharan Africa (Table 3). ASMR and ASDR trends mirrored each other: both metrics significantly worsened in thirteen Regions (with the best/worst performances in Oceania/Andean Latin America GBD Regions for mortality rate, and High-Income North America/Andean Latin America for DALYs rate, respectively). These thirteen Regions belong to five Super Regions (except South Asia and Sub-Saharan Africa). As for ASMR and ASDR, both were stable in the remaining eight GBD Regions; none experienced more favorable mortality and DALYs rates over time. The author has nothing to report. Roberto Passera acknowledges unpaid participation on the Data Safety Monitoring Board of the clinical trial “Consolidation with ADCT-402 (loncastuximab tesirine) after immunochemotherapy: a phase II study in BTKi-treated/ineligible Relapse/Refractory Mantle Cell Lymphoma (MCL) patient”; unpaid membership in the EBMT Statistical Committee, European Society for Blood and Marrow Transplantation; previous membership of the IRB/IEC Comitato Etico AO SS. Antonio e Biagio Alessandria-ASL AL-VC; all outside the submitted work. All data regarding the GBD Study 2023 are available at https://ghdx.healthdata.org.
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