Global, regional, and national burden of retinoblastoma in children aged under 10 years from 1990 to 2021 and projections for future disease burden

Retinoblastoma, the most common intraocular malignancy in children, represents a significant global health challenge, particularly in low- and middle-income countries, where delayed diagnosis and limited access to care persist. Despite advances in diagnostic and therapeutic approaches, disparities in disease burden remain pronounced. Data on retinoblastoma incidence, prevalence, deaths, and disability-adjusted life years (DALYs) from 1990 to 2021 were extracted from the Global Burden of Disease Study 2021. Countries were categorized into 21 regions, with additional classification by Socio-demographic Index. Linear regression analysis was used to estimate the annual percentage change in age-standardized rates, and future trends were projected using a Bayesian age-period-cohort model. The global incidence of retinoblastoma increased from 4674 cases in 1990 to 6,275 cases in 2021, with the age-standardized incidence rate (ASIR) rising from 0.076 (95% UI: 0.049,0.097) to 0.094 (95% UI: 0.058,0.126) per 100,000 population (EAPC 1.35, 95% CI 1.13-1.56). Prevalence similarly grew, reaching 57,333 cases in 2021 (age-standardized prevalence rate (ASPR): 0.861 per 100,000 (EAPC 1.36, 95% CI 1.15-1.57)). Global DALYs and deaths decreased over the study period, indicating improved survival. However, substantial regional disparities remain: Eastern Sub-Saharan Africa persistently bore the highest burden, while Australasia reported minimal cases. Projections for 2035 suggest a modest rise in ASIR (0.102 (95% UI: 0.049-0.156)), ASPR (0.948 (95% UI: 0.482-1.414)), and the age-standardized DALYs rate (4.187 (95% UI: 2.614-5.760)) per 100,000, while the age-standardized death rate is anticipated to slightly decline from 0.042 (95% UI: 0.041-0.043) to 0.039 (95% UI: 0.023-0.055) per 100,000. The findings highlight a dual trajectory: declining mortality and DALYs amid rising incidence and prevalence, signaling improved survival but an increasing burden on healthcare systems. These results underscore the urgency for equitable public health interventions to enhance early detection, treatment accessibility, and long-term care, particularly in high-burden regions. Strategic investment in healthcare infrastructure and targeted policies is essential to mitigate the growing global burden of retinoblastoma.