Global Burden of Leukemia Attributable to Smoking from 1990 to 2021: A Systematic Analysis of the Global Burden of Disease Study 2021

Abstract

Background:
Leukemia is a major hematologic malignancy worldwide. Cigarette smoking is a modifiable risk factor, yet its global contribution to leukemia burden remains underexplored.

Methods:
We analyzed data from the Global Burden of Disease (GBD) 2021 study for 204 countries and territories, 1990–2021. Outcomes included deaths, death rates, disability-adjusted life years (DALYs), DALY rates, and population attributable fraction (PAF). Analyses were stratified by sex, age, subtype, and socio-demographic index (SDI). Temporal trends were evaluated using estimated annual percentage change (EAPC).

Results:
Globally, smoking-attributable leukemia deaths increased from 23,738 (95% UI: 8,438–40,223) in 1990 to 34,151 (12,152–57,975) in 2021 (+43.9%), while DALYs rose from 565,148 (204,203–961,259) to 719,825 (263,395–1,207,483) (+27.4%). Age-standardized death rate (ASDR) declined slightly from 0.445 to 0.433 per 100,000 (EAPC –0.11%, 95% CI –0.13 to –0.08), and DALY rate from 10.596 to 9.122 per 100,000 (EAPC –0.52%, 95% CI –0.55 to –0.49). PAFs increased modestly for deaths (9.60% to 10.66%) and DALYs (4.84% to 6.56%). In 2021, men had over fivefold higher ASDR than women (0.723 vs 0.140 per 100,000), and accounted for most DALYs (606,412 vs 113,413). The burden rose sharply with age, peaking in ≥75 years. AML contributed nearly half of smoking-attributable deaths, followed by CLL, ALL, and CML. The highest ASDR was observed in high-SDI regions (>0.6 per 100,000).

Conclusions:
Smoking remains a substantial, preventable contributor to leukemia burden, particularly AML, disproportionately affecting men and older populations. Despite declining rates, the rising absolute burden highlights the urgency of strengthening tobacco control and integrating smoking cessation into leukemia prevention.