Abstract
BACKGROUND: Childhood and adolescent brain and central nervous system cancers (CABCs) represent the leading cause of cancer-related mortality among individuals aged 0-19 years; however, global trends and socio-demographic disparities remain insufficiently explored. METHODS: We utilized the Global Burden of Disease (GBD) 2021 dataset to evaluate the evolving burden of CABCs across 204 countries from 1990 to 2021. We analyzed age-standardized prevalence rate (ASPR), age-standardized incidence rate (ASIR), age-standardized mortality rate (ASMR), and age-standardized disability-adjusted life years (ASDR) among individuals aged 0-19 years. Methodological approaches, including Joinpoint regression, decomposition analysis, and age-period-cohort modeling, were applied to assess trends across five Sociodemographic Index (SDI) levels. Data robustness was further enhanced through temporal smoothing and adjustments to the mortality-to-incidence ratio for pediatric populations. RESULTS: Globally, ASPR exhibited a modest increase (average annual percentage change [AAPC] = 0.42, 95% CI: 0.29-0.54), while ASIR, ASMR, and ASDR demonstrated significant declines (AAPC = -0.29, -1.31, and -1.34, respectively). High-SDI regions experienced the highest ASPR (18.0 per 100,000) and ASIR (2.6 per 100,000), a reflection of advanced diagnostic capabilities and improved survival outcomes. In contrast, Low-SDI regions saw an upward trajectory in both mortality (AAPC = 0.06) and disability-adjusted life years (DALYs) with the burden disproportionately affecting children under 5 years of age. East Asia accounted for the highest burden of cases (63,271 prevalent cases in 2021), while Sub-Saharan Africa exhibited alarming increases in the incidence among young children. Decomposition analysis revealed that the global reduction in DALYs (-498,553) was predominantly offset by population growth and rising prevalence in low-resource settings. CONCLUSION: While advancements in medical care have contributed to the reduction of CABC mortality in high-SDI regions, persistent disparities in Low-SDI areas necessitate urgent interventions. Targeted strategies-such as scalable diagnostic tools, establishment of regional treatment hubs, and equitable financial support through global initiatives like the WHO Childhood Cancer Initiative-are crucial to addressing these disparities. This study underscored the dual challenge of enhancing survivorship outcomes in high-income settings while rectifying systemic healthcare gaps in low-resource regions to promote global equity in pediatric oncology care.