AML Incidence and Mortality in Adults Over 60 Rose Steadily From 1990-2021, Led by Population Aging and Modifiable Risks

The observational GBD study quantified AML burden using incidence, prevalence, mortality and DALY metrics across 204 countries. Age-standardized rates in 2021 stood at 8.18, 8.31, 7.73 and 140.24 per 100,000 respectively. Rates rose with age, peaking at 90-94 years for most metrics, and were higher in men and high-SDI regions. Decomposition attributed the bulk of growth to population expansion rather than risk-factor shifts alone. Smoking, elevated BMI and occupational benzene or formaldehyde exposure emerged as leading modifiable contributors. These patterns align with prior GBD leukemia reports but extend them by isolating the 60+ demographic and forecasting to 2050. The analysis highlights that high-SDI countries already carry disproportionate loads, likely reflecting both better detection and cumulative exposures. What prior coverage under-emphasized is the interaction with geriatric comorbidities and uneven access to intensive therapies such as allogeneic transplant or targeted agents. Aging populations will amplify these gaps unless health systems integrate geriatric oncology assessments earlier. Prevention focused on smoking cessation, weight management and workplace protections offers clearer near-term leverage than treatment advances alone. Next steps require interventional trials testing risk-reduction packages in older cohorts and prospective registries tracking real-world outcomes after guideline-directed therapy. Updated GBD releases should stratify by treatment access to separate incidence trends from survival effects.