# Childhood cancer burden and health inequality: A systematic analysis from the global burden of diseases study 2021

## TL;DR

This study analyzes global trends in childhood cancer burden from 1990 to 2021, highlighting persistent health inequalities and the need for improved access to care in low-income regions.

## Contribution

The study provides a comprehensive global analysis of childhood cancer burden and inequality using the latest GBD 2021 data, revealing trends and disparities by region and socioeconomic status.

## Key findings

- Childhood cancer caused 70.45 million DALYs globally in 2021, with most burden in low-socio-demographic index countries.
- Global age-standardized DALY rates declined from 1990 to 2021, but inequalities widened, with low-SDI countries disproportionately affected.
- Brain cancers were more common in children aged 10–14, while leukemia dominated in younger children.

## Abstract

To estimate the burden, trends, and inequalities of childhood cancers (aged 0–14 years) at global, regional, and national levels from 1990 to 2021.

We analyzed Global Burden of Diseases Study (GBD) 2021 data, using age-standardized disability-adjusted life years (DALYs) rates (ASDR) to assess childhood cancer burden across 204 countries and territories, grouped into 21 GBD regions by the socio-demographic index (SDI). Temporal trends were assessed using Joinpoint regression. The slope index of inequality and concentration index were calculated to quantify absolute and relative inequalities in the disease burden.

In 2021, childhood cancer caused 70.45 million (95% uncertainty interval [UI]: 57.7–82.79) DALYs globally, with 98.6% attributed to years of life lost. Global ASDR declined from 664.31 (95% UI: 552.99–785.90) in 1990 to 354.06 (95% UI: 289.08–417.49) per 100,000 in 2021. Low-SDI countries had the highest ASDR (467.41, 95% UI: 342.00–589.20), reflecting challenges in diagnosis, treatment, and healthcare access. Acute lymphoblastic leukemia dominated the burden in children under 5, while brain cancers were more common in the 10−14 age group. Boys exhibited higher ASDR (395.55, 95% UI: 307.57–477.68) versus girls (309.80, 95% UI: 253.75–364.91). Socioeconomic inequalities widened, with DALYs concentration index shifting from −0.03 (95% CI: −0.06–0.01) in 1990 to −0.13 (95% CI: −0.16 - −0.11) in 2021, reflecting disproportionate burdens in low-SDI countries.

Persistent disparities in childhood cancer outcomes highlight systemic inequities in healthcare access. High-SDI countries achieved significant mortality reductions, while low-SDI countries face escalating burdens due to delayed diagnoses and fragmented care. Prioritizing cost-effective innovations, strengthening healthcare infrastructure, and implementing gender-sensitive policies are critical to achieving Sustainable Development Goals 3.4 targets. Global collaboration to expand cancer registries and equitable resource allocation is urgently needed to mitigate disparities.