A Comparative Analysis of Multiple Myeloma Disease Burden in China and Globally From 1990 to 2023 and Future Trend Projections.

Abbreviations

Average annual percentage change

Age‐standardized disability‐adjusted life years rate

Age‐standardized incidence rate

Age‐standardized mortality rate

Age‐standardized prevalence rate

Bayesian age‐period‐cohort

Crude DALY rate

Confidence interval

Crude incidence rate

Crude mortality rate

Crude prevalence rate

Disability‐adjusted life years

Global burden of disease

International Classification of Diseases

Multiple myeloma

Uncertainty interval

Introduction

Multiple myeloma (MM) is the second most common blood cancer after non‐Hodgkin lymphoma. It involves the abnormal proliferation of clonal plasma cells in the bone marrow and the secretion of monoclonal immunoglobulins, leading to bone disease, anemia, hypercalcemia, and kidney problems [ 1 , 2 ]. Survival has improved with new therapies, including proteasome inhibitors, immunomodulators, and monoclonal antibodies [ 3 , 4 ]. However, MM remains incurable and places a heavy burden on patients, families, and healthcare systems [ 5 ]. Globally, MM accounts for about 1% of all cancers and 10% of hematologic malignancies [ 6 ]. The disease burden of MM shows substantial spatial, temporal, and demographic variation. Incidence is highly age‐related; most cases are diagnosed in people aged 65 and older [ 7 ]. Population aging may contribute to this rising disease burden [ 8 ]. Advances in diagnostics have also contributed to the increased incidence [ 9 ]. However, the burden and challenges vary across regions due to differences in socioeconomic development, healthcare access, and demographics [ 10 ].

As a populous nation, China is experiencing rapid population aging and shifts in its cancer spectrum. Recent Global Burden of Disease (GBD)‐based studies have assessed the burden of MM at global and national levels, consistently reporting rising incidence and prevalence, with the highest burden among older adults and males [ 11 , 12 , 13 , 14 ]. However, prior GBD‐based analyses have reported the global and national burden of MM using data through 2019 or 2021 [ 12 , 15 ]. The most recent GBD 2023 estimates have not yet been applied to update MM burden assessments. A structured comparison of MM burden between China and the global population, including incidence, prevalence, mortality, and disability‐adjusted life years (DALYs), has not been performed, and sex‐specific Bayesian age‐period‐cohort (BAPC) projections have not been conducted to identify emerging sex‐specific epidemiologic patterns in China. Accurately characterizing the epidemiological features and future trends of MM in China is essential for informing healthcare resource allocation and the development of targeted intervention strategies. This study uses GBD 2023 data to systematically analyze and compare long‐term trends in the incidence, prevalence, mortality, and DALYs of MM in China and globally from 1990 to 2023. It analyzes age and sex patterns and uses sex‐stratified BAPC modeling to project incidence trends through 2050. The goal is to provide scientific evidence for MM prevention and control planning in China.

Methods

Data Sources

Data for this study were obtained from the Global Burden of Disease Study 2023 (GBD 2023) using the GBD Results Tool (data extraction date: November 1, 2025) [ 16 ]. MM was defined according to the standard GBD cause definition (cause ID: 486), which maps to the International Classification of Diseases, Ninth Revision (ICD‐9) code 203 and the Tenth Revision (ICD‐10) code C90 [ 17 ]. The GBD project uses standardized methods to systematically assess disease burden across 369 diseases and injuries in 204 countries and regions worldwide [ 18 ]. Data are collected from multiple sources, including population censuses, vital registries, disease registries, and surveys. They are modeled using tools such as the Cause of Death Ensemble model (CODEm) and spatio‐temporal Gaussian process regression [ 15 ]. Estimates of incidence, prevalence, mortality, and DALYs were extracted directly from the GBD Results Tool. Age‐standardized rates were calculated using the GBD world population age standard to account for differences in age structure across populations. The following age groups were included: all ages, age‐standardized, and 5‐year age groups from < 20 to > 95 years. Because this study uses only publicly available, de‐identified aggregated data, institutional ethics committee approval was not required.

Statistical Analysis

Our statistical analysis primarily consists of two parts: disease burden trend analysis and future incidence projections. In this manuscript, 95% uncertainty intervals (UIs) are reported for GBD‐derived estimates and BAPC model projections, reflecting the combined uncertainty from input data, model specifications, and estimation procedures. In contrast, 95% confidence intervals (CIs) are reported for Joinpoint regression‐derived average annual percentage changes (AAPCs), to reflect sampling variability.

Disease Burden Trend Analysis

Joinpoint regression software (Version 5.1.0; National Cancer Institute, USA) was used to calculate the AAPC and its 95% CI for age‐standardized incidence rate (ASIR), age‐standardized prevalence rate (ASPR), age‐standardized mortality rate (ASMR), and age‐standardized DALY rate (ASDR) from 1990 to 2023. The maximum number of joinpoints was set to 6 to capture potential trend changes over the study period adequately. Model selection was performed using the permutation test (overall significance level = 0.05; number of permutations = 4,499; parametric method). A log‐linear model (ln(y) = xb) was applied to estimate annual percent changes (APC). Errors were assumed to be uncorrelated; thus, first‐order autocorrelation was not considered. An AAPC with a 95% CI that did not include zero was considered statistically significant.

Incidence Projections

The Bayesian age‐period‐cohort (BAPC), which is particularly suited for projecting long‐term trends by smoothing age, period, and cohort effects, was used to project sex‐specific incidence rates in China and globally through 2050 [ 19 ]. A second‐order random walk (RW2) prior was used for the age, period, and cohort effects. Based on the GBD incidence data from 1990 to 2023, a data matrix was constructed using 5‐year age groups (< 20 to > 95). Population projections for 2024–2050 were obtained from the Global Fertility, Mortality, Migration, and Population Forecasts 2017–2100, produced by the Institute for Health Metrics and Evaluation and available through the GBD Foresight visualization tool. The model first projects age‐specific incidence rates, then multiplies them by the GBD world standard population weights and sums them across age groups to obtain projected age‐standardized incidence rates, ensuring consistency with the GBD 2023 estimates used for comparison. Period effects were predicted using random walk methods. The 95% intervals for projected age‐standardized rates were derived directly from the posterior distribution using the 2.5th and 97.5th percentiles, ensuring non‐negative incidence rates. Sensitivity analyses were performed by (1) restricting the observation period to 2000–2023 and (2) replacing the RW2 prior with a first‐order random walk (RW1) prior. Modeling was performed using the BAPC package in R software (version 4.4.2). All analyses were conducted in R, with p  < 0.05 indicating statistical significance.

Results

Description of the Burden of MM in China and Globally

Incidence of MM in China and Globally

In China, the number of incident cases of MM increased approximately eightfold from 1990 to 2023, and the ASIR rose from 0.30 (95% UI: 0.18–0.52) to 0.94 (95% UI: 0.62–1.34) per 100,000. Globally, the ASIR increased from 1.59 (95% UI: 1.33–1.97) to 1.95 (95% UI: 1.55–2.45) per 100,000. The AAPC for incidence was 3.70% (95% CI: 2.57–4.83) in China, substantially exceeding the global rate of 0.65% (95% CI: 0.48–0.82) (Table  1 ).

TABLE 1 All‐age cases and age‐standardized incidence, prevalence, mortality, and DALY rates and corresponding AAPC of multiple myeloma in China and globally in 1990 and 2023. Location Measure 1990 2023 1990–2023 AAPC All‐ages cases Age‐standardized rates per 100,000 people All‐ages cases Age‐standardized rates per 100,000 people
n (95% UI)
n (95% UI)
n (95% UI)
n (95% UI)
n (95% CI) China Incidence 2,723 (1,671–4,731) 0.30 (0.18–0.52) 21,574 (14,296–30,467) 0.94 (0.62–1.34) 3.70 (2.57–4.83) Prevalence 6,059 (3,081–12,311) 0.63 (0.32–1.27) 84,707 (40,874–145,818) 3.71 (1.78–6.5) 5.70 (4.52–6.85) Deaths 2,269 (1,479–4,021) 0.26 (0.17–0.46) 12,204 (9,095–14,783) 0.53 (0.4–0.64) 2.67 (1.43–3.92) DALYs 70,649 (46,072–124,988) 7.18 (4.69–12.74) 320,550 (237,321–384,497) 14.32 (10.7–17.22) 2.55 (1.25–3.87) Global Incidence 60,975 (51,278–76,071) 1.59 (1.33–1.97) 177,776 (141,789–223,397) 1.95 (1.55–2.45) 0.65 (0.48–0.82) Prevalence 154,336 (100,459–271,723) 3.84 (2.52–6.75) 558,546 (358,177–855,771) 6.08 (3.9–9.32) 1.46 (1.31–1.61) Deaths 48,658 (45,078–52,650) 1.31 (1.21–1.42) 125,107 (112,789–137,033) 1.38 (1.24–1.51) 0.17 (−0.04–0.38) DALYs 1,165,905 (1,067,578–1,268,993) 29.18 (26.78–31.72) 2,813,375 (2,537,766–3,135,687) 30.72 (27.71–34.24) 0.18 (−0.08–0.44) Abbreviations: AAPC, average annual percentage change; CI, confidence interval; DALYs, disability‐adjusted life years; UI, uncertainty interval.

All‐age cases and age‐standardized incidence, prevalence, mortality, and DALY rates and corresponding AAPC of multiple myeloma in China and globally in 1990 and 2023.

Abbreviations: AAPC, average annual percentage change; CI, confidence interval; DALYs, disability‐adjusted life years; UI, uncertainty interval.

Prevalence of MM in China and Globally

Prevalent cases in China increased by 1,298.04% from 1990 to 2023, with the ASPR rising from 0.63 (95% UI: 0.32–1.27) to 3.71 (95% UI: 1.78–6.50) per 100,000. Globally, the ASPR rose from 3.84 (95% UI: 2.52–6.75) to 6.08 (95% UI: 3.90–9.32) per 100,000. The AAPC for prevalence was 5.70% (95% CI: 4.52–6.85) in China and 1.46% (95% CI: 1.31–1.61) globally (Table  1 ).

MM Mortality in China and Globally

MM deaths in China increased by 437.86% from 1990 to 2023, and the ASMR rose from 0.26 (95% UI: 0.17–0.46) to 0.53 (95% UI: 0.40–0.64) per 100,000. Globally, the ASMR increased from 1.31 (95% UI: 1.21–1.42) to 1.38 (95% UI: 1.24–1.51) per 100,000. The AAPC for mortality was 2.67% (95% CI: 1.43–3.92) in China and 0.17% (95% CI: −0.04–0.38) globally (Table  1 ).

DALYs For MM in China and Globally

DALYs attributable to MM in China increased by 353.72% from 1990 to 2023, with the ASDR rising from 7.18 (95% UI: 4.69–12.74) to 14.32 (95% UI: 10.70–17.22) per 100,000. Globally, the ASDR increased from 29.18 (95% UI: 26.78–31.72) to 30.72 (95% UI: 27.71–34.24) per 100,000. The AAPC for DALYs was 2.55% (95% CI: 1.25–3.87) in China and 0.18% (95% CI: −0.08–0.44) globally (Table  1 ).

Joinpoint Regression Analysis of MM Burden in China and Globally

Joinpoint regression analysis of ASIR, ASPR, ASMR, and ASDR for MM in China and globally from 1990 to 2023 is depicted in Figures  1 and 2 . In China, all four indicators showed a significant upward trend during the 1990s, followed by a transient decline between 2000 and 2004, after which they resumed a steady upward trajectory through 2023 ( p  < 0.05). The detailed APC values for each segment are annotated in Figures  1 and 2 . Globally, ASIR showed a modest increase from 1990 to 2023, whereas ASPR showed a significant overall increase ( p  < 0.05). ASMR and ASDR showed fluctuations with an overall small increase. A side‐by‐side comparison of China and global trends is presented in Figure  3 .

Changes in age‐standardized (A) incidence, (B) prevalence, (C) mortality, and (D) disability‐adjusted life years of multiple myeloma in China, 1990–2023.

Changes in age‐standardized (A) incidence, (B) prevalence, (C) mortality, and (D) disability‐adjusted life years of multiple myeloma globally, 1990–2023.

Comparison of changes in age‐standardized incidence rate (ASIR), prevalence rate (ASPR), mortality rate (ASMR), and disability‐adjusted life years rate (ASDR) of multiple myeloma in China and globally, 1990–2023.

MM Burden in Different Age Groups in China and Globally in 1990 and 2023

Figures  4 and 5 show the incidence, prevalence, mortality, and DALYs of MM across age groups in China and globally from 1990 to 2023, along with the corresponding crude rates. Overall, the patterns in China were similar to the global trends. In terms of incidence, MM was highly concentrated among people aged 50 and older. In 1990, the crude incidence rate (CIR) of MM in China rose from the 20–24 age group to a peak in the 70–74 age group, then declined. By 2023, the peak had shifted to the 75–79 age group, followed by a decline that may partly reflect the smaller population size in the oldest age strata. Globally, the peak occurred in the 85–94 age group (Figures  4A and 5A ). Prevalence increased in the 20–24 age group, peaked among older adults, and then declined. The crude prevalence rate (CPR) was markedly higher in 2023 than in 1990, following a similar rise‐and‐fall pattern; it peaked in the 70–74 age group in China, compared with the 80–90 age group globally (Figures  4B and 5B ). For mortality and DALYs, the number of deaths and DALYs initially rose with age and then declined. Globally, however, both the crude mortality rate (CMR) and crude DALY rate (CDR) increased steadily with age, indicating that older populations experienced higher mortality and DALYs. In contrast, in China, both rates declined after peaking (Figures  4C,D , 5C,D ).

Age‐specific counts and crude rates of multiple myeloma in China, 1990 vs. 2023. (A) Incident cases and crude incidence rate (CIR). (B) Prevalent cases and crude prevalence rate (CPR). (C) Deaths and crude mortality rate (CMR). (D) Disability‐adjusted life year (DALY) counts and crude DALY rate (CDR). Bars represent counts; lines represent crude rates.

Age‐specific counts and crude rates of multiple myeloma globally, 1990 vs. 2023. (A) Incident cases and and crude incidence rate (CIR). (B) Prevalent cases and crude prevalence rate (CPR). (C) Deaths and crude mortality rate (CMR). (D) Disability‐adjusted life year (DALY) counts and crude DALY rate (CDR). Bars represent counts; lines represent crude rates.

Sex Differences in MM Burden Across Age Groups in China and Globally

The MM burden was consistently higher in males than in females across all age groups in both China and globally in 1990 and 2023 (Figures  6 , 7 , 8 , 9 ). Over the study period, the incident cases and DALYs shifted toward older age groups in both sexes. In China, the peak age for incident cases moved from 65–69 years in 1990 to 70–74 years in 2023 for both sexes; for prevalent cases, the peak shifted from 60–64 and 65–69 years. Globally, the peak age for incident cases shifted from 65–69 and 70–74 years, and for prevalent cases from 65–69 and 70–74 years. The peak age for deaths and DALYs followed a similar pattern, with China's peaks occurring at slightly younger ages than the global peaks in both periods. Detailed age‐ and sex‐stratified counts for each indicator are presented in Figures  6 , 7 , 8 , 9 .

Age‐specific counts of multiple myeloma by sex in China, 1990. (A) Incident cases. (B) Prevalent cases. (C) Deaths. (D) Disability‐adjusted life years (DALYs).

Age‐specific counts of multiple myeloma by sex in China, 2023. (A) Incident cases. (B) Prevalent cases. (C) Deaths. (D) Disability‐adjusted life years (DALYs).

Age‐specific counts of multiple myeloma by sex globally, 1990. (A) Incident cases. (B) Prevalent cases. (C) Deaths. (D) Disability‐adjusted life years (DALYs).

Age‐specific counts of multiple myeloma by sex globally, 2023. (A) Incident cases. (B) Prevalent cases. (C) Deaths. (D) Disability‐adjusted life years (DALYs).

Figures  10 and 11 illustrate the temporal trends in MM burden by sex in China and globally from 1990 to 2023. In China, the number of incident and prevalent cases increased annually for both males and females, peaking in 2022. The growth rate accelerated during the 1990s, declined between 2000 and 2004, and subsequently resumed a slower upward trend. After 2000, the gap between males and females widened modestly. Globally, incident and prevalent cases also rose each year for both sexes, but the rate of increase was slower than in China. Global mortality and DALY counts increased over time, although age‐standardized mortality and DALY rates showed little net change. Overall, both the absolute number of cases and the age‐standardized rates for all four indicators increased substantially in China. In contrast, globally, the increases were driven primarily by increases in incidence and prevalence. Males consistently bore a higher disease burden than females in both populations.

Trends in multiple myeloma burden by sex in China, 1990–2023. (A) Incident cases and age‐standardized incidence rate (ASIR). (B) Prevalent cases and age‐standardized prevalence rate (ASPR). (C) Deaths and age‐standardized mortality rate (ASMR). (D) Disability‐adjusted life year (DALY) counts and age‐standardized DALY rate (ASDR). Bars represent counts; lines represent age‐standardized rates.

Trends in multiple myeloma burden by sex globally, 1990–2023. (A) Incident cases and age‐standardized incidence rate (ASIR). (B) Prevalent cases and age‐standardized prevalence rate (ASPR). (C) Deaths and age‐standardized mortality rate (ASMR). (D) Disability‐adjusted life year (DALY) counts and age‐standardized DALY rate (ASDR). Bars represent counts; lines represent age‐standardized rates.

Projections of MM Burden

To project trends beyond 2023, we applied Bayesian age‐period‐cohort models to forecast ASIR by sex from 2024 to 2050 (Figure  12 ). The model‐fitted ASIR in 2023 was 0.89 per 100,000 for Chinese females and 1.28 for Chinese males. By 2050, the median projected ASIR for Chinese females was 1.63 per 100,000, whereas that for Chinese males was 0.73. Globally, the fitted ASIR in 2023 was 1.89 per 100,000 for females and 2.59 per 100,000 for males, and by 2050, the median projected ASIRs were 3.99 and 3.42, respectively. The point estimates suggest a possible sex‐specific crossover in China by 2050. The posterior probability that female ASIR exceeds male ASIR in 2050 was 56.7%, and the 95% posterior intervals were wide and overlapping, particularly for China (Table  S1 ). Sensitivity analyses showed that narrowing the observation window to 2000–2023 yielded a 2050 ASIR of 2.26 for Chinese females and 1.03 for males, and switching from a second‐order to a first‐order random walk prior left the projections essentially unchanged (Figure  S1 and Table  S2 ).

Projected age‐standardized incidence rates of multiple myeloma by sex in China and globally, 2024–2050. (A) Chinese males. (B) Chinese females. (C) Global males. (D) Global females. Shaded areas denote 95% uncertainty intervals (UIs).

Discussion

The overall trends observed in this study are broadly consistent with prior GBD‐based analyses, which reported rising MM incidence and prevalence globally, with a higher burden among older adults and males [ 14 , 20 ]. However, several findings warrant specific comparison. First, the rising MM burden in China has been reported using GBD 2021 data; our analysis using GBD 2023 extends this observation, showing that China's rate of increase (AAPC: 3.70% for incidence) continues to substantially outpace the global average (0.65%). Second, birth cohort effects on MM risk in China, with the greatest increase among post‐1970s birth cohorts, have been reported [ 13 ]. Our BAPC projections extend this finding, suggesting that cohort‐related risk exposures may differ by sex and contribute to the projected divergence in male and female incidence. Third, and most pronounced, the projected tendency for female ASIR to surpass male ASIR in China by 2050 has not been reported in prior studies, including a recent projection analysis that did not identify this projected reversal [ 12 ]. This novel finding adds a new dimension to the existing literature and warrants further investigation.

The present study found that the burden of MM was consistently higher in males than in females throughout the study period. This finding is consistent with the known sex distribution of disease risk [ 12 ]. However, projections of future incidence rates revealed an important trend: by 2050, ASIR in Chinese females is projected to potentially exceed that in males. Several factors may contribute to this change. First, socio‐demographic changes play a fundamental role: Chinese females have a longer life expectancy and a higher proportion of older adults, and they experience a longer cumulative period of MM risk exposure, which may contribute to higher incidence rates [ 21 ]. Second, differences in biological mechanisms may be associated with this trend [ 22 ]. Recent studies have shown that sex‐specific dysregulation of exosomal non‐coding RNA profiles in male and female MM patients may affect the tumor microenvironment and disease progression [ 23 ]. The expression and function of genes such as Ephrin B2 may exhibit sex‐specific variations in MM, potentially influencing cell survival, proliferation, and chemosensitivity [ 24 ]. Third, behavioral and environmental factors cannot be ignored. Obesity is an important global health problem and has been recognized as being associated with an increased risk of MM [ 25 , 26 ]. High body mass index (BMI) is not only a risk factor for MM but also molecularly linked to genomic instability and cancer development [ 27 ]. Studies in Asian populations have further confirmed that high BMI has been associated with an increased mortality risk in MM [ 28 , 29 ]. The prevalence of overweight and obesity among Chinese adult females, particularly those in the middle‐aged and older age groups, is increasing rapidly [ 30 ]. In addition, sex disparities in healthcare access may also play a role. Globally, women face systemic barriers to timely care [ 31 ]. In China, female patients have been shown to experience longer delays between symptom onset and seeking medical attention than males, especially in rural areas [ 32 ]. Similarly, when early‐stage MM lacks specific symptoms, diagnostic delays may result in progression to advanced stages in female patients. However, direct evidence for such disparities in MM care is currently lacking, and further research is needed to clarify this issue. In contrast, the BAPC model suggested a decline in ASIR among Chinese males. The reason for this decrease is not clear. Sensitivity analyses supported the qualitative pattern of female ASIR exceeding male ASIR under different model specifications. However, the projected values for both sexes varied with the observation window, indicating that the point estimates of these projections are model‐dependent, particularly for males. These projections should be interpreted cautiously, given the modest posterior probability of the sex‐specific crossover, the wide intervals, and the inherent uncertainty of long‐range projections.

Beyond the projected sex‐specific reversal, the overall disease burden of MM in China is also influenced by a confluence of demographic, diagnostic, and therapeutic factors. The present study confirmed that the disease burden of MM is highly concentrated among older adults, consistent with globally recognized epidemiological features [ 33 ]. China is experiencing the world's largest and fastest population aging; the continuous rise in the older population has expanded the number of individuals at risk for MM, thereby contributing to the increasing absolute number of incident cases and the rising crude incidence rate [ 34 ]. However, the observed increases in age‐standardized incidence rates suggest that factors beyond aging, such as improvements in diagnostic sensitivity, expanded cancer registry coverage, changes in disease coding practices, and changes in risk factor exposure, may also be contributing [ 12 , 35 ]. Biological mechanisms include age‐related immune senescence and cellular senescence, which play key roles in the pathogenesis of MM, and the senescent microenvironment may promote the malignant transformation of clonal plasma cells [ 35 ]. Monoclonal gammopathy of undetermined significance, a premalignant lesion of MM, has a higher prevalence in the older population, and its risk of progression increases with age [ 36 ]. Improvements in diagnostic capability may partly explain the rapid increase in reported incidence, especially prevalence. Since 2000, advanced techniques such as serum immunofixation electrophoresis, serum free light chain assay, and whole‐body low‐dose CT have been gradually adopted in China, substantially improving the early diagnosis rate and diagnostic accuracy of MM [ 37 , 38 ]. Consequently, cases that might have been missed or misdiagnosed in the past have been recognized earlier and more accurately, raising the reported incidence rate. At the same time, the increasing accessibility of innovative therapies such as proteasome inhibitors, immunomodulators, and monoclonal antibodies has substantially prolonged patient survival and transformed MM into a manageable chronic disease in China [ 39 ]. This dual effect of more cases being diagnosed and patients surviving longer may have contributed to the marked increase in prevalence, which is typical of the epidemiologic transition of cancer experienced by China as an upper‐middle‐income country. It is noteworthy that the MM mortality rate in China has increased less than the incidence and prevalence rates, and that the ASMR has stabilized in recent years, consistent with the positive impact of therapeutic advances in reducing the disease's lethality [ 40 ]. The national mortality surveillance system, maintained by the Chinese Center for Disease Control and Prevention, has been progressively strengthened, as reflected in the cause‐of‐death surveillance datasets covering 2004–2021 [ 41 ]. In parallel, the expansion of the National Cancer Registry Program and the implementation of urban and rural cancer early diagnosis initiatives have contributed to broader health system strengthening. These developments, supported by national policies such as the Healthy China 2030 initiative and the China Medium‐ and Long‐Term Plan for the Prevention and Treatment of Chronic Diseases (2017–2025), may have improved the detection and reporting of MM cases over the study period [ 42 , 43 ].

However, these evolving trends in China differ from the global picture. Although the global burden of MM remains higher than that in China, its growth trend is relatively flat. This may reflect differences in disease burden stages and in prevention and control systems across regions [ 44 ]. In most developed countries, the MM burden has plateaued due to earlier entry into deeply aging societies and mature diagnostic and treatment systems [ 45 ]. In many developing countries, the true burden may be underestimated due to limited diagnostic capacity and data reporting systems [ 14 ]. The situation in China is somewhere in between. The burden is currently below the global average but rising rapidly. These circumstances suggest a window of opportunity for effective interventions and underscore the importance of learning from the experiences of high‐burden countries.

There are several limitations to this study. First, all analyses were based on the model‐estimated data from the GBD program, which were systematically corrected. However, their accuracy depended on the quality of the original data source and the model assumptions, which may introduce bias [ 46 ]. In China, cancer registry coverage has improved considerably since the 1990s but remains incomplete at the national level. As a result, estimates for earlier years and for less developed provinces rely more on model predictions than on direct registry counts. This introduces uncertainty in the precise estimates, although the overall trends are presumably reliable. Second, the diagnosis of MM is highly dependent on specific assays, such as immunofixation, serum free light chain assessment, and bone marrow biopsy, in the absence of which it may be readily underdiagnosed [ 47 ]. In parts of China where these tests were not widely available, some cases were probably never diagnosed, and the diagnostic criteria themselves have changed several times over the past three decades, which would also affect how cases are counted [ 2 , 48 , 49 ]. Third, disease coding has shifted, most notably the shift from ICD‐9 to ICD‐10, and coding training has improved, which may have influenced case ascertainment [ 17 ]. Fourth, the BAPC model extrapolates past trends and cannot anticipate major changes, such as a curative therapy or a nationwide screening program; therefore, the long‐term projections should be interpreted with caution [ 50 ]. Fifth, we could not assess cytogenetic risk, treatment details, or response to therapy, all of which strongly influence individual outcomes. Finally, we were confined to national totals; geographic, urban–rural, and socioeconomic differences within China could not be explored, although they are important for designing targeted interventions.

To address MM challenges, several evidence‐based strategies merit consideration. First, cancer registration and disease surveillance for older adults and high‐risk populations should be strengthened through active follow‐up and dynamic data updates. Second, clinical awareness of MM should be raised among primary care and geriatric clinicians to facilitate diagnostic evaluation of patients with suggestive symptoms, such as unexplained anemia, bone pain, or renal dysfunction. In parallel, Public awareness of MM should be improved to promote early recognition and timely care‐seeking. Third, to enable earlier diagnosis, improve access to immunofixation electrophoresis and serum free light chain assay. Finally, to enhance access and affordability of innovative therapies, leverage national health insurance negotiations and multi‐tiered protection mechanisms.

Conclusion

This study demonstrated that the disease burden of MM in China showed a rapid increase during 1990–2023, with age‐standardized incidence, prevalence, mortality, and DALY rates increasing substantially faster than the global average. Improved diagnostics, therapeutic advances, and changes in risk factor exposure may have contributed to this trend. Projections suggest that by 2050, the incidence rate among Chinese females may surpass that among males, constituting a new priority for prevention and control. However, this projected crossover should be interpreted with caution given the wide uncertainty intervals. In summary, MM has become a growing public health challenge in China. To respond effectively, there is an urgent need to develop a comprehensive prevention and control strategy that integrates aging‐related strategies, improves early diagnosis through better access to diagnostic testing, optimizes access to treatment, and strengthens public education.

Author Contributions

Fuhong Zhu: conceptualization, methodology, supervision, funding acquisition, writing – original draft, writing – review and editing, software, data curation, validation, formal analysis, visualization, resources, project administration. Huiting Wang: software, data curation, writing – original draft, writing – review and editing, visualization, investigation, validation, formal analysis.

Funding

The authors have nothing to report.

Consent

The authors have nothing to report.

Conflicts of Interest

The authors declare no conflicts of interest.

Supporting information

Table S1: BAPC model‐fitted and projected age‐standardized incidence rates (per 100,000) for MM, 2023 and 2050.

Table S2: Sensitivity analyses of projected age‐standardized incidence rates (per 100,000) for multiple myeloma in China, 2050.

Figure S1: Observation‐window sensitivity analysis for projected ASIR in China. (A) Chinese males. (B) Chinese females. Shaded areas denote 95% UIs. Solid lines represent the main analysis (1990–2023); dashed lines represent the sensitivity analysis (2000–2023).