Background: Myelodysplastic syndromes (MDS), myeloproliferative neoplasms (MPN), and related hematopoietic neoplasms (collectively MDS/MPN) represent a heterogeneous group of clonal myeloid neoplasms. Limited comprehensive understanding of their global epidemiology hinders effective public health strategies. This study aimed to systematically assess the global burden, temporal trends, geographical distribution, and health disparities of these myeloid neoplasms from 1990 to 2021, at global, regional, and national levels.

Methods: Data from the Global Burden of Disease (GBD) 2021 database were analyzed to assess MDS, MPN, and MDS/MPN distribution patterns across different age groups, geographic regions, and socio-demographic index (SDI) quintiles. Temporal trends in incidence, mortality, and disability-adjusted life years (DALYs) were quantified using the annual average percentage change (AAPC) with 95% uncertainty intervals (UI). Health inequality was assessed using slope and concentration indices, integrated with age-period-cohort (APC) modeling. Decomposition analysis was performed to quantify the contributions of population growth, aging, and epidemiological transitions. Temporal trends were examined using joinpoint regression, and future disease burden projections (2022-2050) were generated via Bayesian Age-Period-Cohort (BAPC) modeling.

Results: From 1990 to 2021, the global burden of MDS, MPN, and MDS/MPN consistently increased. In 2021, the age-standardized incidence rate (ASIR) reached 3.96 per 100,000 (95% UI: 3.39-4.66), with age-standardized mortality rate (ASMR) and age-standardized DALY rates (ASDR) of 0.68 (95% UI: 0.58-0.79) and 14.56 (95% UI: 12.50-17.32) per 100,000, respectively. Despite substantial increases in total cases and DALYs, the AAPC of ASIR (0.02), ASMR (0.60), and ASDR (0.36) remained relatively stable. Globally, population growth and aging were the primary drivers of increasing disease burden, while epidemiological changes had a minimal impact and a mitigating effect in some cases. Significant disparities were observed across gender, age, and SDI levels. Males and older adults (aged ≥70 years) exhibited a higher disease burden, with gender and age gaps widening over time and increasing SDI. Notably, the disease burden among individuals aged 15–49 years rose rapidly. Health inequalities intensified, as evidenced by the DALY slope index rising from 13.82 in 1990 to 28.19 in 2021 and the concentration index increasing from -0.27 to -0.21. Geographic heterogeneity persisted, with higher age-standardized rates in high-SDI regions compared to low-SDI regions. A non-linear relationship between SDI and disease burden emerged: when the SDI reached approximately 0.68, the disease burden began to rise slowly from a lower baseline, transitioning to faster growth. When the SDI approached 0.82, this relationship reversed. Within the SDI range of 0.68–0.82, the burden was positively correlated with SDI. The projection model suggested a potential reduction in disease burden by 2050, with the ASIR declining to 3.14 per 100,000, the ASMR to 0.53 per 100,000, and the ASDR to 10.53 per 100,000.

Conclusion: The increasing burden of MDS, MPN, and MDS/MPN since 1990 highlighted a growing public health challenge, especially in aging populations. High-SDI countries bore a disproportionate share of the burden, with persistent and widening health disparities. The heightened vulnerability of males and elderly populations, and rapidly rising burden in middle-aged population, underscore the need for targeted public health interventions and resource allocation to address the rising prevalence of these myeloid neoplasms.

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2025
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