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

e19083 Background: Burkitt lymphoma (BL), an aggressive B-cell non-Hodgkin lymphoma, shows marked geographic variation, with highest incidence in sub-Saharan Africa but rising recognition in South Asia linked to improved diagnostics and possible infectious or immune triggers. Methods: This study utilized age-standardized mortality rates (ASMR per 100,000) for Burkitt lymphoma from the IHME Global Burden of Disease 2023 database, covering South Asia and its key countries (Bangladesh, Bhutan, India, Nepal, Pakistan) from 1990 to 2023, stratified by sex. Historical trends were quantified using estimated annual percentage change (EAPC) derived from log-linear regression of ASMR. Future mortality projections to 2050 were generated using autoregressive integrated moving average (ARIMA) time-series models fitted to historical data, yielding point forecasts and 95% prediction intervals (PI). Results: In South Asia (Both sexes), ASMR increased from 0.03 (1990) to 0.04 (2023), EAPC +0.71% (95% CI +0.62 to +0.81); males +0.53% (+0.44 to +0.62), females +0.94% (+0.80 to +1.09). Country-level variation was pronounced: Bangladesh Both stable at EAPC -0.19% (-0.45 to +0.08), ASMR 0.03 (1990) to 0.04 (2023), projected to 0.03 (0.02–0.04) by 2050; Bhutan Both sharply rising EAPC +0.97% (+0.71 to +1.23), ASMR 0.03 (1990) to 0.04 (2023), forecast 0.06 (0.04–0.07) in 2050; India Both modest decline EAPC -0.15% (-0.27 to -0.03), ASMR 0.02 (1990) to 0.02 (2023), forecast 0.02 (0.02–0.02) in 2050; Nepal Both increase EAPC +0.22% (+0.04 to +0.39), ASMR 0.03 (1990) to 0.03 (2023), forecast 0.03 (0.03–0.04) in 2050; Pakistan Both rapid rise EAPC +1.02% (+0.91 to +1.13), ASMR 0.10 (1990) to 0.13 (2023), forecast 0.16 (0.14–0.18) in 2050. Sex-specific trends showed pronounced female increases in Pakistan EAPC +1.78% (+1.61 to +1.96) and Bhutan +1.76% (+1.54 to +1.97). ARIMA projections forecast continued South Asia rise to 0.05 (0.04–0.06) by 2050, with Pakistan reaching 0.16, Bhutan 0.06, while India and Bangladesh stabilize near 0.02–0.03. Conclusions: BL mortality in South Asia rose modestly overall from 1990–2023, driven by rapid increases in Pakistan, Bhutan, and Nepal while India and Bangladesh remained stable or declined slightly. Projections to 2050 indicate further rise in high-burden areas. Location Sex EAPC Lower 95%CI Upper 95%CI Bangladesh Both -0.19 -0.45 0.08 Bangladesh Female -0.32 -0.69 0.05 Bangladesh Male -0.06 -0.24 0.12 Bhutan Both 0.97 0.71 1.23 Bhutan Female 1.76 1.54 1.97 Bhutan Male 0.51 0.20 0.82 India Both -0.15 -0.27 -0.03 India Female -0.23 -0.36 -0.11 India Male -0.07 -0.21 0.07 Nepal Both 0.22 0.04 0.39 Nepal Female -0.24 -0.54 0.06 Nepal Male 0.52 0.40 0.64 Pakistan Both 1.02 0.91 1.13 <jats:td colspan="1" content-type="row-heading" rowspan="1"