The disparity and trend of childhood cancer burden in survival perspective: a systematic analysis for the global burden of disease 2021.
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BACKGROUND: The World Health Organization Global Initiative for Childhood Cancer has set a target of achieving a 60% survival rate by 2030. However, current evidence is insufficient to guide governments and medical institutions in developing the necessary policies and interventions to reach this goal. Therefore, it is imperative to systematically evaluate the current status and trends of childhood cancer survival worldwide. METHODS: Focusing on mortality-to-incidence ratio (MIR), disability-adjusted life-years (DALY), and death, the study described the distribution and trends of these survival related indicators for childhood cancer using the data from GBD2021. The study characterized the disease spectrum of childhood cancer in Sociodemographic Index (SDI) regions and predicted the future trend using ARIMA mo MIR reflected the disparities in global countries and regions; Jointpoint model and age-period-cohort model were used to analyze the long-term trend; finally, the DALY of childhood cancer contribute to risk factors was assessed. RESULTS: In 2021, 25 level 3 childhood cancers contributed to 114.50 thousand (95% UI 104.70-124.31) death and 9343.21 thousand (95% UI 8529.00-10157.41) DALYs globally, and the MIR was 0.41 (IQR 0.26-0.58). In the high SDI region, brain and central nervous system cancers have ranked first in age-standardized DALY rate (AS-DALY) and age-standardized death rate (ASDR), and it is estimated that the AS-DALYs of nervous system cancer likely to surpass those of hematologic malignancy by 2024. The childhood cancer burden decreased with increasing SDI levels. The largest MIR [31.83 (95%UI 20.38-53.14)] between low and high SDI region was observed in eye cancer, followed by testicular cancer, Hodgkin lymphoma, and malignant skin melanoma (MIR > 10) in 2021. There has been a global downward trend in AS-DALYs and ASDR for childhood cancer; however, breast cancer has been increasing continuously. Although the number, rate, period risk, and cohort risks for childhood cancer DALY decreased across all SDI regions, the absolute burden increased by 35.92% (95% CI: 11.64 to 67.70) in low SDI region, with a concurrently observed rise in the absolute value and risks for nervous system cancer. Besides, the DALY rate of liver cancer attributable to drug use consistently increased, especially in high SDI region. CONCLUSION: This study identified several key points newly and could contribute to more precise recommendations for childhood cancer healthcare. It is imperative to pay more attention to the first rank on DALY of brain and central nervous system cancer in high SDI region, setting the priority to narrow the burden gap on retinoblastoma, testicular cancer, Hodgkin lymphoma, and malignant cutaneous melanoma through conducting more economical and inclusive interventions worldwide. Also, breast cancer and drug use-induced liver cancer should not be ignored.