Temporal trends in the incidence of non-Hodgkin lymphoma in the Middle East and North Africa over the past three decades.

Abstract

Background: Non-Hodgkin lymphoma (NHL) is the most common hematologic malignancy globally, with rising incidence, particularly in high-income countries. While global trends indicate an expanding burden, the epidemiology of NHL in the Middle East and North Africa (MENA) remains understudied. This study uses data from the Global Burden of Disease (GBD) database to analyze NHL incidence trends across the MENA over the past three decades. Methods: Data on age-standardized incidence rates (ASIR) for NHL in the MENA from 1990 to 2019 were obtained from the GBD database. Joinpoint analysis software was used to calculate the annual percent change (APC) and average annual percent change (AAPC) in ASIR, with stratification by sex and country. Results: From 1990 to 2019, 464,321 NHL cases were reported in the MENA, with 61.5% of cases in males. A significant increase in ASIR was observed across the region, with an AAPC of 1.30 (95%CI 1.27 to 1.33, p<0.001). Significant increases were observed in Saudi Arabia (AAPC 3.49, 95%CI 3.45 to 3.55, p<0.001) and Libya (AAPC 2.33, 95%CI 2.27 to 2.40, p<0.001), while Afghanistan showed a decline (AAPC -0.10, 95%CI -0.15 to -0.03, p=0.007). Kuwait and Bahrain showed no significant changes. Sex-based stratification revealed a decline for males in Afghanistan, Yemen, and Bahrain, while females in most countries saw significant increases, except for Kuwait, where a decline was observed (AAPC -1.07, 95%CI -1.57 to -0.47, p<0.001). Among females, the UAE had the highest increase (AAPC 4.21), followed by Saudi Arabia (AAPC 4.10) and Iran (AAPC 3.12). Conclusions: Our analysis shows a significant rise in NHL incidence across the MENA from 1990 to 2019, with males accounting for the majority of cases. The overall increase in ASIR (AAPC of 1.30) aligns with global trends, especially in Saudi Arabia and Libya. However, Afghanistan showed a decline in ASIR, while Kuwait and Bahrain showed no significant changes. Sex-based stratification reveals significant increases in ASIR for females in most countries, except Kuwait. The UAE saw the highest increase among females. These trends underscore the need for region-specific healthcare strategies to address the growing NHL burden in the MENA.