CLL incidence burden and its change trends
Globally, during the last 30 years, CLL-related incidence cases increased significantly from 40,537 in 1990 to 103,467 in 2019, with ASIR rising from 0.76/100,000 persons in 1990 to 1.34/100,000 persons in 2019 (EAPC: 1.86, 95% CI: 1.79~1.92) (Table 1) (Fig.1a). The incidence differs by sex. CLL incidence cases were more common in males than females (male: female in ASIR = 1.13:1 in 1990, and 1.14:1 in 2019). Based on SDI-stratified regional analysis, the number of incidence cases and respective ASIR increased in all SDI categories between 1990 and 2017, with high-SDI quintiles exhibiting the highest incidence cases of 44,387 and the highest ASIR at 4.38/100,000 persons in 2019 (EAPC: 1.11, 95% CI: 1.08~1.15). Of note, the most rapid increase was observed in middle-SDI quintiles during the 30 years (ASIR: 0.18 in 1990 and 0.65 in 2019, EAPC: 5.19, 95% CI: 5.07~5.32). In the geographical region levels, Western Europe, and High-income North America had the most incidence cases in 2019 (Western Europe: 13,428 in 1990 and 27,560 in 2019; High-income North America: 12,210 in 1990 and 20,723 in 2019). Western Europe, High-income North America, and Central Europe displayed the highest ASIR in 2019 (ASIR of Western Europe: 6.32/100,000 persons; ASIR of High-income North America: 5.68/100,000 persons; ASIR of Central Europe: 5.63/100,000 persons). East Asia, Central Europe, and Andean Latin America showed rapidest growth (EAPC of East Asia: 7.98, 95% CI: 7.86~8.10; EAPC of Central Europe: 4.99, 95% CI: 4.95~5.03; EAPC of Andean Latin America: 4.65, 95% CI: 4.48~4.82). In the country or territory level, of 204 countries and territories, the USA, China, and India were the 3 countries with the highest incidence cases of CLL in 2019 (The USA: 18,319; China: 15,910; India: 7,673) (Table S1) (Fig.2a). Croatia, Monaco, and Slovenia displayed the highest ASIR in 2019 (ASIR of Croatia: 9.46/100,000 persons; ASIR of Monaco: 8.68/100,000 persons; ASIR of Slovenia: 8.27/100,000 persons) (Table S2) (Fig.3a). Moreover, Albania, China, and Jamaica had the most rapid increase in ASIR (EAPC of Albania: 8.22, 95% CI: 8.14~8.30; EAPC of China: 8.14, 95% CI: 8.03~8.26; EAPC of Jamaica: 7.57, 95% CI: 7.43~7.72) (Table S3).
Table1
The incidence of CLL in 1990 and 2019 and its temporal trends.
|
1990
|
2019
|
1990-2019
|
|
Incident cases
No*102 (95% CI)
|
ASIR/100,000
No. (95% CI)
|
Incident cases
No*102 (95% CI)
|
ASIR/100,000
No. (95% CI)
|
EAPC
No. (95% CI)
|
Overall
|
405.37 (371.18-427.52)
|
0.76 (0.69-0.80)
|
1034.67 (934.64-1189.42)
|
1.34 (1.21-1.54)
|
1.86 (1.79-1.92)
|
Sex
|
|
|
|
|
|
Male
|
215.53 (187.96-229.36)
|
0.80 (0.70-0.85)
|
552.83 (488.69-665.21)
|
1.42 (1.26-1.71)
|
1.78 (1.71-1.85)
|
Female
|
189.85 (175.20-204.20)
|
0.71 (0.66-0.77)
|
481.84 (427.87-552.37)
|
1.25 (1.11-1.43)
|
1.93 (1.86-1.99)
|
Socio-demographic factor
|
|
|
|
|
|
High SDI
|
236.29 (216.67-252.13)
|
2.87 (2.64-3.07)
|
443.87 (384.09-545.65)
|
4.38 (3.79-5.38)
|
1.11 (1.08-1.15)
|
High-middle SDI
|
102.93 (92.68-112.12)
|
0.89 (0.81-0.97)
|
306.56 (276.18-343.40)
|
2.14 (1.93-2.40)
|
3.13 (3.07-3.18)
|
Middle SDI
|
31.21 (26.08-36.15)
|
0.18 (0.15-0.21)
|
154.59 (135.14-179.99)
|
0.65 (0.56-0.75)
|
5.19 (5.07-5.32)
|
Low-middle SDI
|
23.75 (19.78-28.18)
|
0.21 (0.18-0.25)
|
82.58 (71.86-95.17)
|
0.47 (0.41-0.54)
|
2.84 (2.71-2.97)
|
Low SDI
|
11.02 (8.74-13.48)
|
0.21 (0.17-0.26)
|
32.86 (27.61-38.60)
|
0.29 (0.24-0.34)
|
1.27 (1.13-1.41)
|
Region
|
|
|
|
|
|
Andean Latin America
|
0.35 (0.29-0.44)
|
0.09 (0.08-0.12)
|
1.99 (1.54-2.49)
|
0.31 (0.24-0.39)
|
4.65 (4.48-4.82)
|
Australasia
|
6.06 (5.50-7.02)
|
2.99 (2.71-3.46)
|
15.18 (11.84-19.98)
|
5.22 (4.07-6.87)
|
1.55 (1.52-1.58)
|
Caribbean
|
1.48 (1.32-1.63)
|
0.42 (0.37-0.46)
|
3.73 (3.09-4.52)
|
0.79 (0.65-0.96)
|
2.31 (2.22-2.40)
|
Central Asia
|
2.32 (1.94-2.61)
|
0.33 (0.28-0.38)
|
4.94 (4.12-6.00)
|
0.53 (0.44-0.64)
|
1.61 (1.51-1.72)
|
Central Europe
|
17.30 (15.70-20.20)
|
1.41 (1.28-1.64)
|
64.36 (54.75-78.94)
|
5.63 (4.79-6.91)
|
4.99 (4.95-5.03)
|
Central Latin America
|
2.27 (2.03-2.41)
|
0.14 (0.1-0.15)
|
9.59 (7.94-11.77)
|
0.38 (0.32-0.47)
|
3.43 (3.29-3.57)
|
Central Sub-Saharan Africa
|
0.60 (0.41-0.91)
|
0.11 (0.07-0.16)
|
2.94 (1.97-4.26)
|
0.22 (0.15-0.32)
|
2.61 (2.44-2.78)
|
East Asia
|
20.22 (15.23-26.47)
|
0.17 (0.12-0.22)
|
162.14 (133.32-199.11)
|
1.10 (0.91-1.35)
|
7.98 (7.86-8.10)
|
Eastern Europe
|
37.52 (30.60-44.07)
|
1.66 (1.35-1.95)
|
74.24 (65.51-84.31)
|
3.54 (3.12-4.02)
|
2.85 (2.81-2.89)
|
Eastern Sub-Saharan Africa
|
4.15 (3.18-5.22)
|
0.22 (0.17-0.27)
|
12.70 (10.31-15.83)
|
0.31 (0.25-0.38)
|
1.27 (1.14-1.41)
|
High-income Asia Pacific
|
4.58 (4.25-5.54)
|
0.26 (0.24-0.32)
|
12.67 (10.38-15.68)
|
0.68 (0.55-0.84)
|
3.27 (3.17-3.37)
|
High-income North America
|
122.10 (110.16-129.00)
|
4.35 (3.92-4.59)
|
207.23 (174.82-255.27)
|
5.68 (4.80-7.00)
|
0.41 (0.38-0.44)
|
North Africa and Middle East
|
6.94 (5.50-8.51)
|
0.20 (0.16-0.25)
|
31.52 (26.99-37.75)
|
0.52 (0.44-0.62)
|
3.40 (3.28-3.52)
|
Oceania
|
0.02 (0.02-0.03)
|
0.03 (0.02-0.04)
|
0.05 (0.04-0.07)
|
0.04 (0.03-0.05)
|
0.25 (-0.11-0.62)
|
South Asia
|
26.94 (22.35-32.58)
|
0.25 (0.20-0.30)
|
97.47 (82.93-113.40)
|
0.54 (0.46-0.63)
|
2.71 (2.59-2.83)
|
Southeast Asia
|
4.31 (3.57-5.25)
|
0.09 (0.08-0.11)
|
19.17 (15.35-4.23)
|
0.28 (0.23-0.36)
|
3.99 (3.81-4.16)
|
Southern Latin America
|
2.73 (2.37-3.07)
|
0.55 (0.48-0.62)
|
6.10 (4.77-7.89)
|
0.91 (0.71-1.18)
|
1.25 (1.17-1.32)
|
Southern Sub-Saharan Africa
|
3.78 (3.20-4.34)
|
0.72 (0.61-0.83)
|
9.19 (7.91-10.41)
|
1.17 (1.01-1.32)
|
1.83 (1.77-1.90)
|
Tropical Latin America
|
3.19 (2.93-3.41)
|
0.21 (0.19-0.22)
|
12.64 (11.13-14.69)
|
0.57 (0.50-0.66)
|
3.57 (3.45-3.68)
|
Western Europe
|
134.28 (123.30-142.03)
|
3.49 (3.21-3.69)
|
275.60 (235.01-338.18)
|
6.32 (5.39-7.75)
|
1.79 (1.76-1.82)
|
Western Sub-Saharan Africa
|
4.25 (3.47-4.98)
|
0.22 (0.18-0.26)
|
11.23 (8.99-13.34)
|
0.25 (0.20—0.25)
|
0.41 (0.27-0.55)
|
CLL, chronic lymphocytic leukemia; ASIR, age-standardized incidence rate; EAPC, estimated annual percentage changes; SDI, social-demographic index. |
CLL death burden and its change trends
Global deaths cases of CLL had a prompt growth from 21,548 in 1990 to 44,613 in 2019, with ASDR rising from 0.40/100,000 persons in 1990 to 0.58/100,000 persons in 2019 (EAPC: 1.17, 95% CI: 1.07~1.27) (Table 2) (Fig.1b). The death gap between male and female continuously shrank and even reversed in the past 30 years (male: female in ASIR = 1.05:1 in 1990, and 0.98:1 in 2019). Based on SDI-stratified regional analysis, the number of death cases and corresponding ASDR increased in all SDI categories between 1990 and 2017, with high-SDI quintiles showing the highest death cases of 15,312 and the highest ASDR at 1.51/100,000 persons in 2019 (EAPC: 0.53, 95% CI: 0.48~0.59). Of note, the promptest death was observed in middle-SDI quintiles during the 30 years (ASDR: 0.15 in 1990 and 0.33 in 2019, EAPC: 3.09, 95% CI: 2.95~3.24). In the geographical region levels, Western Europe, South Asia, and High-income North America had the largest number of death cases in 2019 (Western Europe: 6,300 in 1990 and 10,043 in 2019; South Asia: 2,535 in 1990 and 7,876 in 2019; High-income North America: 4,469 in 1990 and 6,696 in 2019). The highest ASDR was found in Central Europe, Western Europe, and High-income North America in 2019 (ASDR of Central Europe: 2.31/100,000 persons; ASDR of Western Europe: 2.30/100,000 persons; ASDR of High-income North America: 1.84/100,000 persons). East Asia, Central Europe, and Andean Latin America showed the rapidest growth (EAPC of East Asia: 4.34, 95% CI: 4.18~4.50; EAPC of Central Europe:3.76, 95% CI: 3.71~3.82; EAPC of Andean Latin America: 3.61, 95% CI: 3.42~3.80). In the country or territory level, India, the USA, and China were the 3 countries with the highest death cases of CLL in 2019 (India: 6,196; The USA: 5,942; China: 4,712) (Table S4) (Fig.2b). Croatia, Latvia, and Lithuania displayed the highest ASDR in 2019 (ASDR of Croatia: 9.46/100,000 persons; ASDR of Latvia: 8.68/100,000 persons; ASDR of Lithuania: 8.27/100,000 persons) (Table S5) (Fig.3b). Moreover, Jamaica, Georgia, and Albania had the rapidest increase in ASDR (EAPC of Jamaica: 7.02, 95% CI: 6.84~7.20; EAPC of Georgia: 6.71, 95% CI: 6.55~6.86; EAPC of Albania: 6.45, 95% CI: 6.34~6.55) (Table S6).
Table2
The death of CLL in 1990 and 2019 and its temporal trends.
|
1990
|
2019
|
1990-2019
|
|
Death cases
No*102 (95% CI)
|
ASDR/100,000
No. (95% CI)
|
Death cases
No*102 (95% CI)
|
ASDR/100,000
No. (95% CI)
|
EAPC
No. (95% CI)
|
Overall
|
215.48 (198.11-230.27)
|
0.40 (0.37-0.43)
|
446.13 (403.93-500.74)
|
0.58 (0.52-0.65)
|
1.17 (1.07-1.27)
|
Sex
|
|
|
|
|
|
Male
|
110.64 (96.40-119.16)
|
0.41 (0.36-0.44)
|
223.06 (199.88-263.45)
|
0.57 (0.52-0.68)
|
1.13 (1.03-1.23)
|
Female
|
104.84 (94.93-115.07)
|
0.39 (0.36-0.43)
|
223.06 (198.58-250.84)
|
0.58 (0.51-0.65)
|
1.21 (1.12-1.31)
|
Socio-demographic factor
|
|
|
|
|
|
High SDI
|
99.73 (90.31-106.73)
|
1.21 (1.10-1.30)
|
153.12 (134.33-185.62)
|
1.51 (1.33-1.83)
|
0.53 (0.48-0.59)
|
High-middle SDI
|
57.98 (52.16-63.41)
|
0.50 (0.45-0.55)
|
118.76 (107.42-131.33)
|
0.83 (0.75-0.92)
|
1.70 (1.62-1.78)
|
Middle SDI
|
24.93 (20.97-28.39)
|
0.15 (0.12-0.17)
|
79.10 (69.96-91.07)
|
0.33 (0.29-0.38)
|
3.09 (2.95-3.24)
|
Low-middle SDI
|
22.01 (18.28-26.25)
|
0.19 (0.16-0.23)
|
65.06 (56.04-76.12)
|
0.37 (0.32-0.43)
|
2.20 (2.07-2.34)
|
Low SDI
|
10.73 (8.47-13.10)
|
0.20 (0.16-0.25)
|
79.10 (69.96-91.07)
|
0.26 (0.22-0.31)
|
0.92 (0.77-1.06)
|
Region
|
|
|
|
|
|
Andean Latin America
|
0.31 (0.26-0.39)
|
0.08 (0.07-0.10)
|
1.31 (1.02-1.62)
|
0.21 (0.16-0.25)
|
3.61 (3.42-3.80)
|
Australasia
|
2.53 (2.27-2.90)
|
1.25 (1.12-1.43)
|
4.97 (4.16-6.19)
|
1.71 (1.43-2.13)
|
0.82 (0.77-0.88)
|
Caribbean
|
1.05 (0.93-1.16)
|
0.30 (0.26-0.33)
|
2.09 (1.74-2.46)
|
0.44 (0.37-0.52)
|
1.45 (1.33-1.56)
|
Central Asia
|
1.55 (1.31-1.75)
|
0.22 (0.19-0.25)
|
2.57 (2.14-3.12)
|
0.27 (0.23-0.33)
|
0.62 (0.49-0.75)
|
Central Europe
|
10.42 (9.46-12.72)
|
0.85 (0.77-1.03)
|
26.43 (22.34-31.60)
|
2.31 (1.96-2.77)
|
3.76 (3.71-3.82)
|
Central Latin America
|
1.86 (1.66-1.99)
|
0.11 (0.10-0.12)
|
5.93 (4.91-7.21)
|
0.24 (0.20-0.29)
|
2.51 (2.34-2.67)
|
Central Sub-Saharan Africa
|
0.58 (0.40-0.85)
|
0.10 (0.07-0.15)
|
2.66 (1.79-3.88)
|
0.20 (0.14-0.29)
|
2.39 (2.21-2.56)
|
East Asia
|
14.26 (10.86-18.72)
|
0.12 (0.09-0.15)
|
48.41 (40.03-59.74)
|
0.33 (0.27-0.41)
|
4.34 (4.18-4.50)
|
Eastern Europe
|
22.15 (18.18-25.83)
|
0.98 (0.80-1.14)
|
31.47 (27.70-35.34)
|
1.50 (1.32-1.68)
|
1.33 (1.28-1.39)
|
Eastern Sub-Saharan Africa
|
4.13 (3.17-5.21)
|
0.22 (0.17-0.27)
|
11.89 (9.58-14.73)
|
0.29 (0.23-0.36)
|
1.07 (0.93-1.21)
|
High-income Asia Pacific
|
1.96 (1.81-2.32)
|
0.11 (0.10-0.13)
|
4.19 (3.44-5.37)
|
0.22 (0.18-0.29)
|
2.42 (2.25-2.59)
|
High-income North America
|
44.69 (40.00-47.37)
|
1.59 (1.42-1.69)
|
66.96 (59.17-81.04)
|
1.84 (1.62-2.22)
|
0.10 (0.05-0.15)
|
North Africa and Middle East
|
5.58 (4.41-6.85)
|
0.16 (0.13-0.20)
|
15.70 (13.32-18.90)
|
0.26 (0.22-0.31)
|
1.58 (1.43-1.74)
|
Oceania
|
0.02 (0.01-0.02)
|
0.03 (0.02-0.03)
|
0.04 (0.03-0.05)
|
0.03 (0.02-0.04)
|
0.00 (-0.42-0.41)
|
South Asia
|
25.35 (20.86-30.63)
|
0.23 (0.19-0.28)
|
78.76 (66.31-93.69)
|
0.44 (0.37-0.52)
|
2.11 (1.99-2.24)
|
Southeast Asia
|
3.80 (3.17-4.61)
|
0.08 (0.07-0.10)
|
12.98 (10.59-16.34)
|
0.19 (0.16-0.24)
|
2.99 (2.79-3.18)
|
Southern Latin America
|
2.19 (1.91-2.46)
|
0.44 (0.39-0.50)
|
3.78 (3.31-4.51)
|
0.57 (0.50-0.68)
|
0.45 (0.36-0.54)
|
Southern Sub-Saharan Africa
|
3.25 (2.68-3.77)
|
0.62 (0.51-0.72)
|
7.15 (5.97-8.06)
|
0.91 (0.76-1.03)
|
1.44 (1.36-1.51)
|
Tropical Latin America
|
2.68 (2.46-2.87)
|
0.18 (0.16-0.19)
|
8.62 (7.51-10.10)
|
0.39 (0.34-0.45)
|
2.88 (2.75-3.02)
|
Western Europe
|
63.00 (57.08-66.86)
|
1.64 (1.48-1.74)
|
100.43 (86.91-119.83)
|
2.30 (1.99-2.75)
|
1.02 (0.98-1.07)
|
Western Sub-Saharan Africa
|
4.12 (3.41-4.81)
|
0.21 (0.18-0.25)
|
9.82 (7.89-11.58)
|
0.22 (0.17-0.25)
|
0.02 (-0.13-0.16)
|
CLL, chronic lymphocytic leukemia; ASDR, age-standardized death rate; EAPC, estimated annual percentage changes; SDI, social-demographic index.
|
CLL DALY burden and its change trends
Global DALY cases of CLL increased rapidly from 492,075 in 1990 to 948,464 in 2019, with age-standardized DALY rate rising from 9.20/100,000 persons in 1990 to 12.26/100,000 persons in 2019 (EAPC:0.92, 95% CI: 0.90~0.94) (Table 3) (Fig.1c). The DALY differs by sex. CLL DALY cases were more common in males than females (male: female in age-standardized DALY rate = 1.12:1 in 1990, and 1.04:1 in 2019), with an ongoing narrowing gap. According to SDI-stratified regional analysis, the number of DALY cases and corresponding age-standardized DALY rate increased in all SDI stratifications between 1990 and 2017. Among all SDI stratifications, high-SDI quintiles had the highest DALY cases of 263,263 and the highest age-standardized DALY rate of 25.98/100,000 persons in 2019 (EAPC: 0.06, 95% CI: 0.04~0.07). Of note, the promptest DALY was observed in middle-SDI quintiles during the 30 years (age-standardized DALY rate: 4.28 in 1990 and 8.49 in 2019, EAPC:2.64, 95% CI: 2.62~2.67). In the geographical region levels, South Asia, Western Europe, and East Asia had the largest cases of DALY cases in 2019 (South Asia: 63,887 in 1990 and 182,608 in 2019; Western Europe: 120,195 in 1990 and 161,522 in 2019; East Asia: 52,051 in 1990 and 150,193 in 2019). Central Europe, Western Europe, and Eastern Europe exhibited the highest age-standardized DALY rate in 2019 (age-standardized DALY rate of Central Europe: 46.70/100,000 persons; age-standardized DALY rate of Western Europe: 37.02/100,000 persons; age-standardized DALY rate of Eastern Europe: 34.99/100,000 persons). East Asia, Central Europe, and Andean Latin America showed rapidest growth (EAPC of East Asia: 3.69, 95% CI: 3.66~3.72; EAPC of Central Europe:3.30, 95% CI: 3.29~3.31; EAPC of Andean Latin America: 2.82, 95% CI: 2.78~2.86). In the country or territory level, China, India, and the USA were the 3 countries with the highest DALY cases of CLL in 2019 (China: 146,913; India: 139,769; The USA: 104,663) (Table S7) (Fig.2c). Latvia, Croatia, and Poland displayed the highest age-standardized DALY rate in 2019 (age-standardized DALY rate of Latvia: 65.18/100,000 persons; age-standardized DALY rate of Croatia: 63.75/100,000 persons; age-standardized DALY rate of Poland: 60.25/100,000 persons) (Table S8) (Fig.3c). Besides, Jamaica, Albania, and Georgia had the most rapid increase in age-standardized DALY rate (EAPC of Jamaica: 7.10, 95% CI: 7.06~7.14; EAPC of Albania: 5.95, 95% CI: 5.93~5.97; EAPC of Georgia: 5.80, 95% CI: 5.77~5.83) (Table S9).
Table 3
The DALY of CLL in 1990 and 2019 and its temporal trends.
|
1990
|
2019
|
1990-2019
|
|
DALY cases
No*102 (95% CI)
|
Age-standardized DALY rate/100,000
No. (95% CI)
|
DALY cases
No*102 (95% CI)
|
Age-standardized DALY rate /100,000
No. (95% CI)
|
EAPC
No. (95% CI)
|
Overall
|
4920.75 (4452.50-5322.84)
|
9.20 (8.32-9.95)
|
9484.64 (8741.97-10652.54)
|
12.26 (11.30-13.77)
|
0.92 (0.90-0.94)
|
Sex
|
|
|
|
|
|
Male
|
2620.91 (2263.04-2864.75)
|
9.73 (8.40-10.63)
|
4858.99 (4363.26-5723.79)
|
12.52 (11.24-14.75)
|
0.85 (0.83-0.87)
|
Female
|
2299.84 (2055.07-2577.62)
|
8.66 (7.74-9.70)
|
4625.65 (4120.79-5275.03)
|
11.99 (10.69-13.68)
|
1.01 (0.99-1.03)
|
Socio-demographic factor
|
|
|
|
|
|
High SDI
|
1944.55 (1776.26-2089.29)
|
23.66 (21.61-25.42)
|
2632.63 (2353.15-3229.85)
|
25.98 (23.22-31.87)
|
0.06 (0.04-0.07)
|
High-middle SDI
|
1402.98 (1248.66-1554.35)
|
12.20 (10.85-13.51)
|
2545.13 (2341.45-2840.04)
|
17.79 (16.37-19.85)
|
1.26 (1.24-1.27)
|
Middle SDI
|
734.69 (597.50-867.40)
|
4.28 (348-5.05)
|
2033.96 (1805.27-2342.81)
|
8.49 (7.53-9.78)
|
2.64 (2.62-2.67)
|
Low-middle SDI
|
569.47 (479.14-679.76)
|
5.04 (4.24-6.02)
|
1555.53 (1345.94-1816.49)
|
8.82 (7.63-10.30)
|
1.93 (1.90-1.95)
|
Low SDI
|
266.93 (210.66-325.61)
|
5.05 (3.99-6.17)
|
713.44 (59.46-834.46)
|
6.32 (5.29-7.39)
|
0.77 (0.74-0.80)
|
Region
|
|
|
|
|
|
Andean Latin America
|
8.65 (7.05-10.96)
|
2.27 (1.85-2.87)
|
30.46 (23.15-38.63)
|
4.79 (3.64-6.07)
|
2.82 (2.78-2.86)
|
Australasia
|
48.97 (44.43-57.37)
|
24.15 (21.91-28.29)
|
85.41 (72.99-106.85)
|
29.39 (25.11-36.76)
|
0.35 (0.34-0.36)
|
Caribbean
|
23.04 (20.49-25.55)
|
6.53 (5.81-7.24)
|
43.37 (36.26-51.76)
|
9.20 (7.69-10.97)
|
1.22 (1.20-1.25)
|
Central Asia
|
48.80 (40.69-55.21)
|
7.04 (5.88-7.97)
|
72.53 (60.94-88.87)
|
7.75 (6.52-9.50)
|
0.11 (0.08-0.13)
|
Central Europe
|
237.03 (213.69-284.28)
|
19.28 (17.38-23.12)
|
533.43 (453.28-643.32)
|
46.70 (39.68-56.32)
|
3.30 (3.29-3.31)
|
Central Latin America
|
45.64 (40.66-48.47)
|
2.78 (2.48-2.95)
|
126.43 (104.93-155.05)
|
5.06 (4.20-6.20)
|
2.00 (1.96-2.03)
|
Central Sub-Saharan Africa
|
15.34 (10.57-23.11)
|
2.76 (1.90-4.16)
|
68.29 (45.39-99.00)
|
5.19 (3.45-7.53)
|
2.34 (2.30-2.37)
|
East Asia
|
520.51 (383.84-700.76)
|
4.25 (3.13-5.72)
|
1501.93 (1249.41-1826.59)
|
10.20 (8.49-12.41)
|
3.69 (3.66-3.72)
|
Eastern Europe
|
572.17 (457.99-677.76)
|
25.26 (20.22-29.92)
|
734.59 (642.27-832.19)
|
34.99 (30.59-39.63)
|
0.90 (0.89-0.91)
|
Eastern Sub-Saharan Africa
|
97.46 (74.45-124.07)
|
5.12 (3.92-6.52)
|
265.68 (216.60-332.14)
|
6.45 (5.26-8.07)
|
0.86 (0.83-0.88)
|
High-income Asia Pacific
|
44.68 (41.66-54.63)
|
2.57 (2.40-3.15)
|
75.89 (64.80-93.91)
|
4.05 (3.46-5.01)
|
1.56 (1.3-1.60)
|
High-income North America
|
882.94 (793.23-938.53)
|
31.43 (28.24-33.41)
|
1181.33 (1059.13-1444.17)
|
32.40 (29.05-39.61)
|
-0.34 (-0.32--0.35)
|
North Africa and Middle East
|
154.10 (118.40-191.88)
|
4.47 (3.43-5.56)
|
393.18 (329.89-465.10)
|
6.46 (5.42-7.64)
|
1.17 (1.15 -1.20)
|
Oceania
|
0.55 (0.40-0.73)
|
0.85 (0.62-1.13)
|
1.21 (0.86-1.70)
|
0.91 (0.65-1.28)
|
0.13 (0.05-0.20)
|
South Asia
|
638.87 (529.44-766.80)
|
5.82 (4.82-6.99)
|
1826.08 (1549.90-2178.30)
|
10.12 (8.59-12.07)
|
1.83 (1.81-1.86)
|
Southeast Asia
|
95.06 (79.00-116.84)
|
2.04 (1.69-2.50)
|
290.03 (238.18-364.78)
|
4.30 (3.53-5.41)
|
2.58 (2.54-2.61)
|
Southern Latin America
|
44.39 (38.59-50.01)
|
8.96 (7.79-10.09)
|
67.59 (59.68-80.02)
|
10.13 (8.94-11.99)
|
-0.01 (-0.03-0.02)
|
Southern Sub-Saharan Africa
|
84.00 (72.20-95.27)
|
16.00 (13.75-18.15)
|
170.79 (146.70-196.15)
|
21.74 (18.67-24.96)
|
1.29 (1.27-1.30)
|
Tropical Latin America
|
61.89 (56.85-66.36)
|
4.05 (3.72-4.34)
|
169.91 (152.08-199.02)
|
7.60 (6.80-8.90)
|
2.28 (2.25-2.31)
|
Western Europe
|
1201.95 (1103.38-1289.05)
|
31.25 (28.69-33.52)
|
1615.22 (1433.69-1939.40)
|
37.02 (32.86-44.45)
|
0.40 (0.38-0.41)
|
Western Sub-Saharan Africa
|
94.70 (78.04-111.70)
|
4.92 (4.05-5.80)
|
231.27 (185.09-277.07)
|
5.07 (4.06-6.07)
|
0.12 (0.09-0.15)
|
CLL, chronic lymphocytic leukemia; DALY, disability adjusted life-year; EAPC, estimated annual percentage changes; SDI, social-demographic index. |
The correlation between SDI and EAPC
We evaluated the relationship between ASIR of CLL in 1990 and corresponding EAPC and found that that the EAPC of ASIR was negatively correlated with ASIR in 1990 (correlation coefficient = − 0.19, P = 0.0058), indicating that the CLL incidence of countries and territories with low ASIR could be substantially underestimated (Fig.4a). We then investigated the correlation between SDI in 2019 and EAPC values of ASIR, ASDR, and age-standardized DALY rate in 204 countries and territories. Unfortunately, the results indicated that there was no statistical significance in the correlation between SDI and EAPCs (Fig.4b-d). Eventually, we investigated the correlation between SDI and EAPC values of ASIR, ASDR, and age-standardized DALY rate in 21 regions across the globe. The results indicated that all ASR values displayed an apparent positive correlation with SDI (correlation coefficient of ASIR = 0.70, of ASDR = 0.68, of age-standardized DALY rate = 0.67, all P values < 0.0001) (Fig.5a-c).
Sex and age structure of CLL
We evaluated CLL incidence and ASIR in 3 different age groups: 15~49 years, 50~69 years, and above 70 years in the globe and different regions based on SDI levels. The results revealed that most incidences were occurred in aged 50 years or older in the globe. Furthermore, in the high-SDI region, the incidence cases of patients above 70 years occupied the most proportion. While in the low-SDI region, the incidence cases of patients aged 50~69 years accounted for the highest percentage (Fig.6a). In all age groups, patients aged above 70 years displayed the highest incidence rate, especially in the high-SDI region (Fig.6b).
CLL burden attributable risk factors
Based on GBD 2019, four potential CLL-related mortality and DALY attributable risk factors including high body mass index, occupational exposure to benzene, occupational exposure to formaldehyde, and smoking were identified. Among these risk factors, smoking was the strongest risk factor to CLL-mediated death and DALY from 1990 to 2017 at a global scale (Fig.7a-d). Of note, although the percent of CLL deaths and DALYs attributed to occupational exposure to carcinogens only accounted for a very small proportion, a significantly higher risk of carcinogen exposure was found in low-SDI regions compared to high-SDI regions.