Abstract
BACKGROUND: Multiple myeloma (MM) presents a growing public health challenge in Asia, yet evidence on its epidemiology and risk factors in transitioning economies like China is limited. This study aimed to compare the disease burden, risk factors, and future trends of multiple myeloma between China and the High-Income Asia Pacific (HIC AP) region. METHODS: We conducted an integrated analysis combining data from the Global Burden of Disease (GBD) study 2023 (1993-2023) with a matched case-control study at a tertiary cancer center in China (2021-2025). The case-control component included 235 newly diagnosed MM cases and 235 healthy controls. Exposures of interest were sex, age, body mass index (BMI), and income level. Main outcomes included age-standardized incidence (ASIR), mortality (ASMR), and disability-adjusted life years (DALYs) rates (ASDR); individual-level risk associations; and Bayesian projections to 2040. RESULTS: From 1993 to 2023, China's ASIR increased by 175% (from 0.34 to 0.94 per 100 000), while its ASMR plateaued after 2,000. The HIC AP region maintained high but stable ASIRs (2.00 to 2.13 per 100 000) alongside declining ASMRs. In the case-control study, older age (50-69 years: adjusted odds ratio [aOR], 6.69; 95% confidence interval [CI], 4.08-10.99; ≥70 years: aOR, 6.10; 95% CI, 3.30-11.27) and male sex (aOR, 1.59; 95% CI, 1.06-2.37) were significant risk factors. Sex-stratified analysis revealed that higher BMI (24-27.9 kg/m(2)) was associated with increased risk in males (aOR, 2.14; 95% CI, 1.19-3.85) but not in females (aOR, 0.86; 95% CI, 0.45-1.64). Income level showed no significant association. Projections indicate China's ASIR will continue rising to 2.55 per 100 000 by 2,040 with declining ASMR, while the HIC AP burden remains high and stable. CONCLUSION: China exhibits transitional MM epidemiology characterized by rapidly rising incidence and plateauing mortality, driven by aging and improved healthcare access. The identified sex-specific association between BMI and myeloma risk highlights population heterogeneity. These findings underscore the need for tailored prevention and control strategies for Asia's evolving disease landscape.