| Background Accurate childhood cancer burden data are crucial for resource planning and health policy prioritisation.
Model-based estimates are necessary because cancer surveillance data are scarce or non-existent in many countries.
Although global incidence and mortality estimates are available, there are no previous analyses of the global burden
of childhood cancer represented in disability-adjusted life-years (DALYs).
Methods Using the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017 methodology, childhood
(ages 0–19 years) cancer mortality was estimated by use of vital registration system data, verbal autopsy data, and
population-based cancer registry incidence data, which were transformed to mortality estimates through modelled
mortality-to-incidence ratios (MIRs). Childhood cancer incidence was estimated using the mortality estimates and
corresponding MIRs. Prevalence estimates were calculated by using MIR to model survival and multiplied by
disability weights to obtain years lived with disability (YLDs). Years of life lost (YLLs) were calculated by multiplying
age-specific cancer deaths by the difference between the age of death and a reference life expectancy. DALYs were
calculated as the sum of YLLs and YLDs. Final point estimates are reported with 95% uncertainty intervals.
Findings Globally, in 2017, there were 11·5 million (95% uncertainty interval 10·6–12·3) DALYs due to childhood
cancer, 97·3% (97·3–97·3) of which were attributable to YLLs and 2·7% (2·7–2·7) of which were attributable to
YLDs. Childhood cancer was the sixth leading cause of total cancer burden globally and the ninth leading cause of
childhood disease burden globally. 82·2% (82·1–82·2) of global childhood cancer DALYs occurred in low, low-middle,
or middle Socio-demographic Index locations, whereas 50·3% (50·3–50·3) of adult cancer DALYs occurred in these
same locations. Cancers that are uncategorised in the current GBD framework comprised 26·5% (26·5–26·5) of
global childhood cancer DALYs.
Interpretation The GBD 2017 results call attention to the substantial burden of childhood cancer globally, which
disproportionately affects populations in resource-limited settings. The use of DALY-based estimates is crucial in
demonstrating that childhood cancer burden represents an important global cancer and child health concern.
Funding Bill & Melinda Gates Foundation, American Lebanese Syrian Associated Charities (ALSAC), and St. Baldrick’s
Foundation. |