Statewide Burden and Trends of Acute Myeloid Leukemia in the United States between 1990-2019: A Benchmarking Analysis for the Global Burden of Disease Study 2019

Background: Acute myeloid leukemia (AML) ranks as the 15th leading cause of death, accounting for 1.75% of all cancer-related deaths in the United States of America (USA) in 2019, following Myeloma. Despite its significance, statewide disparities in AML burden have not been previously studied. Thus, this research aimed to assess the burden and trends of AML across the USA over the last three decades, spanning from 1990 to 2019.

Method: Employing the Global Burden of Disease methodology, we evaluated AML prevalence, incidence, mortality, and disability-adjusted life years (DALYs) using standardized approaches and statistical modeling. The results were presented in absolute counts and age-standardized rates (per 100,000 person-years).

Results: The total number of AML prevalence cases rose from 10,124 (95% uncertainty interval (UI): 9,259-11,482) in 1990 to 21,370 (95% UI: 17,759-24,830) in 2019. Correspondingly, deaths increased from 6,849 (95% UI: 6,301-7,724) in 1990 to 13,620 (95% UI: 11,632-14,664) in 2019, while DALYs increased from 185,960 (95% UI: 171,985-210,122) in 1990 to 301,526 (95% UI: 268,606-323,608) in 2019. The age-standardized incidence rate (ASIR) rose from 2.75 (95% UI: 2.52-3.09) to 3.23 (95% UI: 2.71-3.73) cases per 100,000 from 1990 to 2019. Similarly, the age-standardized mortality rate (ASMR) increased from 2.20 (95% UI: 2.03-2.48) to 2.54 (95% UI: 2.19-2.72) cases per 100,000 during the same period. In 2019, the greatest AML incidence was observed in California (1,677), followed by Florida (1,268) and Texas (1,155), while the lowest incidence was observed in the District of Columbia (24). Regarding the annual percentage of change (APC), the highest percentage increase in deaths was observed in Nevada (328%), followed by Alaska (224%), while the District of Columbia had the lowest APC (6%) from 1990 to 2019. In terms of incidence, Nevada (332%) and Arizona (227%) had the highest APC during the same period. The age group of 70-74 years had the highest number of deaths (2,264) and incidence (2,665), as well as DALYs (43,918) in 2019. Notably, the older age groups exhibited the highest APC in deaths and incidence. Males had a higher burden of AML compared to females.

Conclusion: Our study underscores significant disparities in AML burden across different states in the USA from 1990 to 2019. We have also identified that males and elderly individuals face a higher likelihood of AML burden. Consequently, policymakers must prioritize enhancing healthcare systems, advancing early diagnosis and treatment approaches, and promoting health education to reduce individual exposures to relevant risk factors.