Epidemiological trends and burden of retinoblastoma mortality in South Asia: A retrospective analysis from 1990 to 2023 with advanced machine learning forecasting to 2050.

e22610 Background: Retinoblastoma is a rare but highly curable pediatric malignancy, yet mortality remains substantial in low- and middle-income regions. Comprehensive evaluations of long-term mortality trends and future burden in South Asia are limited. We assessed temporal patterns of retinoblastoma mortality from 1990–2023 and projected trends through 2050. Methods: Age-standardized mortality rates (ASMRs) for retinoblastoma were obtained for South Asia and individual countries from 1990–2023 using IHME GBD 2023 data. Temporal trends were quantified using estimated annual percentage change (EAPC) with 95% confidence intervals (CIs), stratified by sex. Machine learning–based ARIMA time-series models were used to forecast ASMRs to 2050 with uncertainty intervals (UI). Results: Across South Asia, retinoblastoma mortality declined significantly from 1990–2023 (both sexes EAPC −3.38; 95% CI −3.63 to −3.13), with a steeper reduction among males (−3.69; −3.94 to −3.44) than females (−3.07; −3.34 to −2.80). Regional ASMRs decreased steadily over the study period, reflecting sustained improvements in survival. India demonstrated the most pronounced decline (both sexes EAPC −4.45; −4.68 to −4.22), with comparable reductions in males (−4.50; −4.76 to −4.25) and females (−4.40; −4.64 to −4.15). Bangladesh experienced substantial decreases in mortality (both sexes EAPC −1.81; −2.19 to −1.43), particularly among females (−2.57; −2.84 to −2.29). Nepal showed consistent declines across sexes, while Bhutan also demonstrated significant reductions. In contrast, Pakistan exhibited near-stable mortality trends (both sexes EAPC −0.23; −0.48 to 0.02), with a slight increase among females (0.08; −0.24 to 0.40). Forecasting analyses suggest continued declines in retinoblastoma mortality across most South Asian countries through 2050, although widening uncertainty intervals indicate persistent disparities. Conclusions: Retinoblastoma mortality has declined substantially across South Asia over the past three decades, with the most rapid improvements observed in India. However, heterogeneous trends highlight persistent inequities in early diagnosis and access to curative care. Location Sex EAPC Lower 95%CI Upper 95%CI Bangladesh Both -1.81 -2.19 -1.43 Bangladesh Female -2.57 -2.84 -2.29 Bangladesh Male -1.24 -1.71 -0.77 Bhutan Both -1.41 -1.79 -1.04 Bhutan Female -0.89 -1.29 -0.48 Bhutan Male -1.92 -2.28 -1.55 India Both -4.45 -4.68 -4.22 India Female -4.40 -4.64 -4.15 India Male -4.50 -4.76 -4.25 Nepal Both -2.34 -2.89 -1.78 Nepal Female -2.37 -2.93 -1.81 Nepal Male -2.31 -2.87 -1.75 Pakistan Both -0.23 -0.48 0.02 Pakistan Female