Global acute myeloid leukemia burden attributable to high body mass index, smoking, and occupational benzene/formaldehyde exposure: a spatiotemporal analysis from 1990 to 2021

Objective To evaluate the global burden of acute myeloid leukemia (AML) attributable to high body mass index (BMI), smoking, benzene exposure, and formaldehyde exposure from 1990 to 2021.Methods A repeated cross-sectional analysis was performed using Global Burden of Disease 2021 data from 204 countries and territories. Age-standardized mortality rates (ASMRs), age-standardized disability-adjusted life year rates (ASDRs) for AML, and estimated annual percentage changes (EAPCs) were calculated.Results Global AML ASMR declined from 1.693 (95% UI, 1.356–2.077) to 1.566 (95% UI, 1.366–1.797) per 100,000. The AML burden attributable to high BMI increased by 19.6% (EAPC: 0.609), whereas smoking-related burden decreased by 26.2% (EAPC: −0.929). Men had a higher burden than women. Benzene/formaldehyde exposure was the leading attributable risk among those aged 15–19 years. High BMI predominated among adults aged ≥20 years, whereas smoking surpassed high BMI in men aged ≥50 years. High sociodemographic index (SDI) regions had the highest absolute burden, whereas High-middle SDI regions showed the fastest increase in high BMI-related burden (+76.6%).Conclusions The global modifiable AML risk pattern is shifting from tobacco-centered to a broader profile involving weight management and occupational exposure. These findings should be interpreted as comparative risk assessment estimates and policy-prioritization signals, rather than individual-level causal attributions.