Global burden and inequalities of Hodgkin and non-Hodgkin lymphoma among children aged 0-14 years, 1990-2021: a GBD 2021 analysis with forecasts to 2035.

OBJECTIVE: Childhood Hodgkin lymphoma (HL) and non-Hodgkin lymphoma (NHL) are potentially curable, but outcomes differ across development levels. The authors assessed global burden and inequalities among children aged 0-14 years from 1990 to 2021 and projected burden to 2035. METHODS: GBD 2021 estimates for 204 locations provided age-standardized incidence, mortality, and disability-adjusted life-year (DALY) rates by sex and Sociodemographic Index (SDI). Estimated annual percentage changes (EAPCs) summarized trends; the slope index of inequality (SII) and concentration index (CII) measured absolute and relative inequalities. An exploratory Country Priority Index (CPI) combined mortality and DALY rates, absolute DALYs, and adverse trajectories. Autoregressive integrated moving average (ARIMA) models generated forecasts. RESULTS: From 1990 to 2021, incidence declined modestly. Mortality declined from 0.152 to 0.095 per 100,000 for HL and from 0.75 to 0.45 for NHL; corresponding DALY rates fell from 12.50 to 7.78 and from 63.38 to 37.83. Boys and low-SDI settings had higher burdens, and SDI was strongly inversely associated with mortality and DALYs. For NHL mortality, the SII improved from -0.91 to -0.61, whereas the CII worsened from -0.38 to -0.49. The CPI ranked Pakistan, Uganda, South Sudan, Zimbabwe, and Nigeria highest. By 2035, projected HL and NHL incidence rates were 0.20 and 0.98, mortality rates 0.08 and 0.35, and DALY rates 6.22 and 27.25 per 100,000, respectively. CONCLUSION: Childhood lymphoma outcomes improved globally, but relative inequalities remained concentrated in lower-SDI settings. CPI-based prioritization supports investment in diagnosis, treatment, essential medicines, supportive care, and surveillance. Forecasts represent conditional baseline trajectories.