Introduction:

Multiple myeloma (MM), historically considered a malignancy of older adults, is increasingly being diagnosed in adolescents and young adults (AYA) aged 15 to 39 years. This study aims to examine the epidemiological trends, incidence and mortality rates, and identify key risk factors associated with AYA MM both globally and within the United States of America (USA).

Methods:

The study analyzed data from 1990 to 2021, obtained from the Global Health Data Exchange 2021 database, which is a comprehensive catalog of global health and demographic data, providing access to a wide range of datasets around the world. This study described the age-standardized rates (ASR) (per 100,000 patient-years) of incidence (ASIR), death (ASDR) and attributable risk factors of AYA MM globally and in the USA. However, the strength of the association has not been validated. We computed a two-sample t-test to get the differences between the ASR of 1990 and 2021. All the statistical analysis was automated using R (version 4.4.1). We used the ARIMA model on the training set up till year 2021, and that model is used for prediction till 2040.

Result:

In 2021, there were an estimated 2,536 incident cases of multiple myeloma (MM) among AYAs globally, and 1,579 deaths. In the USA, 90 new cases and 60 deaths were reported in the same age group in 2021, with an ASIR of 0.08 and an ASDR of 0.05. Globally the ASIR was 0.09 per 100,000 population in 2021 as compared to 0.05 in 1990 (p = 0.003) and ASDR was 0.05 as comapred to 0.03 in 1990 (p < 0.001). Between 1990 and 2021, global ASIR and ASDR demonstrated an increasing trend, with annual percentage changes (APC) of 0.84 and 0.60, respectively. In contrast, both ASIR and ASDR declined in the USA during this period, with APCs of - 0.08 and - 0.17, respectively.

Among 204 countries, In 2021, the highest MM ASIR and ASDR in AYA were observed in Turkmenistan (ASIR: 0.35; ASDR: 0.28). From 1990 to 2021, Mauritius showed the highest APC in both rates (APC of ASIR: 7.30; ASDR: 6.44).

By the States of the USA: In 2021, the highest ASIR of AYA MM in the U.S. was observed in Louisiana (0.14), while the highest ASDR was reported in New Mexico (0.09). State-level trends varied, with the highest increase in ASIR and ASDR seen in North Dakota (APC of ASIR: 0.49; ASDR: 0.31). The greatest decline in both ASIR and ASDR occurred in the District of Columbia (APC of ASIR: -0.62; ASDR: -0.67).

Risk factor: In this database, high BMI (body mass index) was identified as a significant risk factor for MM-related deaths. In 2021, 6.8% of global AYA MM deaths were attributable to high BMI, compared to 11.45% in the USA. From 1990 to 2021, deaths associated with high BMI in AYA MM increased by 47% globally and by 40% in the USA.

Projection: Our analysis predicts that, globally, both ASIR and ASDR of AYA MM will continue to rise through 2040. In contrast, the USA is projected to see a declining trend in both incidence and death rates over the same period.

Conclusion:

While global ASIR and ASDR of AYA MM increased from 1990 to 2021, the United States of America demonstrated a declining trend in both rates. However, geographic disparities persist. The growing contribution of high BMI to AYA MM mortality underscores the importance of addressing modifiable risk factors through targeted public health interventions. Continued surveillance and region-specific strategies are essential to reduce disease burden and improve outcomes for this unique population.

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2025
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