Burden of non-Hodgkin lymphoma in South Asia, 1990–2023: Analysis of the Global Burden of Disease study 2023.

Abstract

e19086 Background: Non-Hodgkin lymphoma (NHL) contributes substantially to the global cancer burden, yet long-term, sex-specific trends in mortality, prevalence, and overall disease burden across South Asia remain incompletely characterised. Using Global Burden of Disease (GBD) 2023 estimates, we quantified temporal changes in NHL burden in the South Asian region from 1990 to 2023. Methods: Using Global Burden of Disease (GBD) 2023 estimates, we analysed age-standardised mortality, prevalence, disability-adjusted life years (DALYs), and years of life lost (YLLs) for non-Hodgkin lymphoma in South Asia from 1990–2023, stratified by sex and country. Temporal trends were quantified using average annual percent change (AAPC) with 95% uncertainty intervals (UI). Results: Between 1990 and 2023, the age-standardised mortality rate for non-Hodgkin lymphoma in South Asia increased from 2.38 (95% UI: 1.78–3.12) per 100,000 to 2.59 (1.90–3.41), with a persistent male excess (2023: males 3.18 [2.10–4.63] vs females 2.02 [1.22–2.96]). Mortality increased in Pakistan (both sexes AAPC: 0.30%; 95% UI: 0.21–0.39) and India (0.16%; 0.05–0.26), remained modestly positive in Bhutan (0.10%; 0.04–0.17), and declined in Nepal (−0.35%; −0.42 to −0.27), where female mortality fell most rapidly (−0.57%; −0.70 to −0.43). Age-standardised prevalence rose substantially across all countries and outpaced mortality trends. In South Asia, prevalence increased from 4.84 (3.35–7.07) per 100,000 in 1990 to 11.0 (6.22–18.9) in 2023 (AAPC: 2.46%; 2.26–2.67). Prevalence more than doubled in Bangladesh (5.08 to 11.9) and India (4.49 to 11.0), and nearly tripled among South Asian females (3.93 to 9.57; female AAPC: 2.70% vs male: 2.34%), likely reflecting improved survival. Country-level prevalence growth was highest in Bangladesh (AAPC: 2.56%; 2.35–2.77) and Pakistan (2.25%; 2.09–2.41), and lowest in Nepal (1.44%; 1.34–1.54). DALY rates declined in Nepal (66.9 [47.0–90.0] to 57.1 [40.0–79.7]; AAPC: −0.46%; −0.55 to −0.37) and Bangladesh (86.3 [61.4–113.0] to 76.1 [52.3–104.9]; −0.29%; −0.38 to −0.20), driven largely by reductions in YLLs. In contrast, DALYs increased in Pakistan (117.5 [83.0–156.9] to 129.9 [93.1–177.2]; AAPC: 0.49%; 0.39–0.59), with the steepest rise among females (0.80%; 0.67–0.92). Regionally, DALY (0.03%; −0.07 to 0.14) and YLL (0.02%; −0.08 to 0.12) trends remained broadly stable due to offsetting country-level patterns. Conclusions: NHL burden in South Asia is characterised by rapidly rising prevalence, persistent male excess mortality, and pronounced cross-country heterogeneity, underscoring the need for country-specific cancer control strategies.