Abstract
BACKGROUND: Childhood cancers are an important cause of premature mortality and long-term disability worldwide, yet most global estimates stop at broad diagnostic groups. A clearer picture by subtype and its social determinants is needed to guide the World Health Organization (WHO) target of at least sixty percent survival for all children with cancer by 2030. METHODS: In this population-based registry study, we analysed incidence and mortality data for 185 countries in 2022 using the GLOBOCAN database, and redistributed unspecified tumours according to subtype proportions derived from 670 high-quality population-based registries in Cancer Incidence in Five Continents XII. For unspecified subtype cases, we assumed they most likely belonged to main subtypes and proportionally reallocated them to specified categories. Age-standardised rates (ASRs) were calculated with the World Standard Population. Multivariable linear regression examined associations between subtype-specific incidence and national socioeconomic and health-system indicators, adjusting for multicollinearity. FINDINGS: An estimated 211,080 new cases and 78,441 deaths due to childhood cancers occurred globally in 2022. Leukaemia was the most common cancer, with acute lymphoblastic leukaemia (ALL) comprising 66.73% of leukaemia cases, and an ASR of 2.04 per 100,000 population. Brain tumours account for 45.00% of brain and central nervous system cancers, with an ASR of 0.56 per 100,000 population. Burkitt lymphoma represented 17.64% of non-Hodgkin lymphoma cases, with the highest number of incidence cases observed in sub-Saharan Africaand an ASR of 0.32 per 100,000 population. Across most subtypes, incidence was higher in boys than girls. Countries with higher Universal Health Coverage service indices and better healthcare infrastructure had significantly higher reported incidence rates for multiple subtypes, including ALL (β = 0.059 [95% CI: 0.0495-0.0689], p < 0.0001) and astrocytic tumours (β = 0.0057 [95% CI: 0.0045-0.0068], p < 0.0001). INTERPRETATION: Subtype-specific childhood cancer incidence varies substantially across regions, reflecting disparities in data quality, healthcare access, and diagnostic capacity. Interpretation should be cautious given limitations in registry coverage, especially in low- and middle-income countries, and the small number of cases for certain subtypes and regions, which may affect accuracy and comparability. Strengthening childhood cancer registration systems is essential to improve surveillance, research, and policy planning. FUNDING: The National Natural Science Foundation of China and Beijing Natural Science Foundation.