Abstract
OBJECTIVE: Leukemia is a key public health challenge in China, with epidemiological patterns shifting due to demographics, environment, and healthcare advances. This study analyzes its trends, risks, and projects future burdens. METHODS: Using the Global Burden of Disease Study 2021 database, we evaluated China's leukemia incidence and mortality during 1990-2021. Joinpoint regression identified temporal trends, while age-period-cohort (APC) models dissected age, period, and birth cohort effects. Decomposition analysis quantified contributions of population aging, growth, and epidemiological changes. Bayesian APC models were used to forecast trends into 2036. Risk factors for leukemia-related deaths and disability-adjusted life years (DALYs) were also analyzed. RESULTS: During 1990-2021, leukemia incidence increased by 38.7 %, while mortality declined by 47.1 %. Males exhibited higher mortality and incidence than females. Age-specific trends revealed dual incidence peaks in children (<5 years) and the elderly (>80 years). Decomposition analysis attributed 76.9 % to population expansion. Smoking and high BMI were leading risk factors. The projections to 2036 show the incidence rate for men will rise. CONCLUSIONS: Despite therapeutic advances reflected in mortality reductions, escalating incidence among aging populations and occupational hazards necessitate urgent action. Prioritizing sex-specific policies, smoking cessation initiatives, and stricter occupational safety regulations is crucial to curbing future burdens.