Leukemia disease burden and quality of care among adolescents and young adults in China compared to global patterns: a comprehensive analysis from 1990 to 2021.
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BACKGROUND: Leukemia is a major global public health challenge, particularly among adolescents and young adults (AYAs) aged 15-39 years, who face distinct biological and social vulnerabilities. This study aimed to systematically assess long-term trends in leukemia burden and quality of care among Chinese AYAs from 1990 to 2021, and to project future trajectories to inform targeted prevention and control strategies. METHODS: Data were obtained from the Global Burden of Disease (GBD) 2021 database. Temporal trends in incidence, prevalence, years of life lost (YLLs), and years lived with disability (YLDs) among AYAs were analyzed across 204 countries and territories. A Bayesian age-period-cohort (BAPC) model was applied to project incidence and prevalence from 2022 to 2036. A Quality of Care Index (QCI), constructed using principal component analysis, was used to evaluate healthcare performance across different Socio-demographic Index (SDI) regions. RESULTS: In 2021, the age-standardized incidence rate (ASIR), prevalence rate (ASPR), YLL rate (ASYLLR), and YLD rate (ASYLDR) for leukemia among Chinese AYAs were 3.64, 17.41, 133.55, and 1.87 per 100,000, respectively. The ASYLLR remained moderately elevated compared to high-income Asia-Pacific nations. From 1990 to 2021, China showed a distinct divergent pattern, with ASPR increasing by 145.9% and ASYLDR by 33.6%, while ASYLLR declined by 52.4%. Males consistently experienced a higher burden than females (incidence sex ratio: 1.62:1). The highest premature mortality burden occurred in the 20-24 age group, while the fastest incidence growth was observed among those aged 25-29 years. Acute lymphoblastic leukemia accounted for the greatest burden, whereas chronic lymphocytic leukemia showed the fastest growth despite low incidence. Projections indicated a modest decline in ASIR but a substantial 70.6% increase in ASPR between 2022 and 2036. China's Quality of Care Index (QCI) reached 74.3%, substantially above the global average (55.2%) and comparable to high-middle SDI regions (71.0%). However, multidimensional analysis revealed specific areas needing improvement, particularly in long-term survivorship care. CONCLUSION: Leukemia burden among Chinese AYAs is characterized by rising morbidity alongside declining mortality. These findings provide a national-level reference for macro-level policy formulation and underscore the need for strengthened prevention, improved long-term survivorship care, and more integrated health system responses. Future research should focus on subnational analyses to generate locally actionable evidence.