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

e19548 Background: Multiple myeloma (MM) is an increasingly important contributor to cancer-related mortality worldwide, yet long-term mortality trends in South Asia remain poorly defined. Understanding sex- and country-specific temporal patterns is essential. This study evaluated historical trends and projected future mortality burden of MM across South Asia from 1990 to 2050. Methods: We conducted a population-based retrospective analysis of age-standardized mortality rates (ASMRs) for multiple myeloma across South Asia from 1990 to 2023, using the Global Burden of Disease 2023 database, stratified by country and sex. Temporal trends were assessed using estimated annual percentage change (EAPC) with 95% confidence intervals (CIs). Advanced machine-learning–based time-series forecasting models were applied to project ASMRs through 2050, with uncertainty quantified using prediction intervals (PI). Results: Between 1990 and 2023, MM mortality increased significantly across South Asia (both sexes EAPC 1.23; 95% CI 1.06–1.40). The rise was more pronounced among females (EAPC 1.68; 95% CI 1.44–1.92) than males (EAPC 0.92; 95% CI 0.80–1.04), although absolute ASMRs remained consistently higher in males. At the country level, Pakistan demonstrated the steepest increase in MM mortality (both sexes EAPC 1.50), followed by India (1.25), Bangladesh (1.10), Nepal (0.58), and Bhutan (0.54). Female mortality increased substantially across all countries, particularly in Pakistan (EAPC 1.84), India (1.73), and Bangladesh (1.57). In contrast, male mortality trends were heterogeneous, with modest increases in most countries and a slight decline observed in Bhutan (EAPC −0.15; 95% CI −0.30 to −0.01). Forecasting analyses project a continued rise in MM mortality through 2050 across South Asia. Regional ASMRs are expected to nearly double, with sharper absolute increases among females and widening prediction intervals beyond 2035. Conclusions: Multiple myeloma mortality has increased steadily across South Asia over the past three decades, with disproportionately rapid rises among females and marked country-level heterogeneity. Forecasts indicate a sustained and growing mortality burden through 2050, underscoring the urgent need for improved early diagnosis, and treatment. Location Sex EAPC Lower 95%CI Upper 95%CI Bangladesh Both 1.10 0.88 1.31 Bangladesh Female 1.57 1.22 1.92 Bangladesh Male 0.83 0.71 0.95 Bhutan Both 0.54 0.42 0.67 Bhutan Female 1.34 1.23 1.45 Bhutan Male -0.15 -0.30 -0.01 India Both 1.25 1.08 1.43 India Female 1.73 1.48 1.97 India Male 0.93 0.79 1.07 Nepal Both 0.58 0.32 0.84 Nepal Female 1.10 0.81 1.40 Nepal Male 0.35 0.11 0.60 Pakistan Both 1.50 1.33 1.67 Pakistan