{"paper_id":"4dbbf505-e912-4717-9ff2-4b9eea83343c","body_text":"Epidemiological Characteristics and Temporal Trends of Malignant Melanoma from 1990 to 2021, with Projections until 2044 | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article Epidemiological Characteristics and Temporal Trends of Malignant Melanoma from 1990 to 2021, with Projections until 2044 Ling Yao, Yonghai Li, Huashang Li, Guixiang Qian, Zhuhui Zhang, and 5 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5813672/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract OBJECTIVE Malignant melanoma, one of the most metastatic human cancers, is on the rise globally. However, its low prevalence leads to insufficient concern and its latest worldwide burden remains unclear. This study aims to update its epidemiological features to prompt timely and impactful interventions. METHODS Weanalysed malignant melanoma incidence, disability-adjusted life years (DALYs), and mortality trends from 1990 to 2021 across 204 countries using GBD 2021 data. We also projected incidence and mortality rates for the next two decades. RESULTS Globally, the age-standardized incidence rate (ASIR) of malignant melanoma in 2021 was 3.6 per 100,000 people with the estimated annual percentage change (EAPC) of the ASIR from 1990–2021 was 0.6%. The age-standardized DALYs rate (ASDR) of malignant melanoma in 2021 was 19.6 per 100,000 people with the ASDR EAPC from 1990 to 2021 was -0.7%. The age-standardized mortality rate（ASMR）of malignant melanoma in 2021 was 0.7 per 100,000 people with the ASMR EAPC from 1990 to 2021 was -0.4%. Australia remained the region with the highest ASIR, ASDR, and ASMR in 2021. Older adult males had higher rates than females for all three measures. The incidence of MM is predicted to remain stable over the next twenty years while the mortality rate will significantly decline. CONCLUSION The global ASIR of malignant melanoma increased from 1990 to 2021, while the ASDR and ASMR decreased during the same period. High-SDI countries and older adult males require enhanced measures for the prevention and control of malignant melanoma. Health sciences/Diseases/Cancer Health sciences/Diseases/Skin diseases Health sciences/Oncology/Cancer/Cancer epidemiology Health sciences/Oncology/Cancer/Cancer prevention Health sciences/Oncology/Cancer/Skin cancer Health sciences/Medical research/Epidemiology Malignant melanoma epidemiological features incidence DALYs mortality sociodemographic index Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Introduction Malignant melanoma (MM), originating from melanocytes in the skin, is the deadliest form of skin cancer due to its high heterogeneity and metastasis potential.[ 1 ] MM is widely attributed to natural sunlight exposure and indoor tanning-induced ultraviolet radiation[ 2 ]. Globally, MM accounts for 1.7% of all diagnosed cancers and ranks as the fifth most common cancer in the United States. Since 1975, there has been a more than 320% increase in MM incidence in developed predominantly white countries [ 3 – 4 ]. Annually, MM causes over 20,000 deaths in Europe with a continuing rise in incidence, resulting in an estimated 325,000 new cases and 57,000 deaths globally in 2020[ 5 ]. Projections indicate that by 2040, there will be approximately 516,000 new cases and 96,000 deaths annually due to MM [ 6 ]. The projected annual cost of treating newly diagnosed MM is expected to escalate from $ 457 million in 2011 to $ 1.6 billion by 2030 [ 7 ]. The distribution of MM exhibits regional disparities. Australia and Aotearoa New Zealand reported the highest incidences [ 8 ]. In Europe, national incidence rates vary significantly among countries and regions by as much as twentyfold while death trends also differ [ 5 ]. Conversely, Asia experiences relatively low burden of skin cancer [ 9 – 10 ]. An up-to-date understanding could stimulate greater concern for high-risk areas prompting targeted early detection efforts along with increased medical resources allocation for prevention and research purposes. However, comprehensive global perspective studies are scarce with most focusing on specific countries or regions; furthermore, current evidence remains lacking [ 11 ]. Notably absent are reports reflecting epidemiological characteristics of MM encompassing all aspects including incidence rates, DALYs (disability-adjusted life years), deaths combined with predictive analysis. To address this gap, we utilized GBD 2021 data from 1990–2021 across 204 countries and 21GBD regions extracting relevant data on incidence, DALYs, and deaths related to MM revealing geographical features, temporal trends, distribution patterns by age, gender and sociodemographic Index (SDI) scores. Moreover, we provided a prediction of the global burden of MM for the next 20 years. Methods GBD uses a standardized statistical framework to analyse cancer registry data and cause-of-death data from countries and different time periods [ 12 ]. DALYs represent the total number of years lost due to disease, disability, or premature death in a specific population and are used to measure the disability burden associated with a disease or condition. SDI is a composite indicator that includes per capita income, average education level of individuals aged 15 and above, and total fertility rate of individuals aged 25 and below. By adjusting the SDI index from 0.00 to 1.00 and then multiplying by 100, it can reflect the five different levels of development of countries and regions: low (< 0.46), low-medium (0.46–0.60), medium (0.61–0.69), high (0.70–0.81), and very High (> 0.81) [ 13 ]. In the International Classification of Diseases, 9th revision (ICD-9), the code for MM is 172.x, where \"x\" represents the type and location of melanoma. According to the ICD-10, the code for MM is C43.x; similarly, \"x\" represents the specific type and location of melanoma. According to the ICD-11, the code for MM is 2B51, and melanoma is included in the chapter on skin tumours. All data sources used in this study can be accessed through the GBD Global Health Data Exchange Index ( http://ghdx.healthdata.org/gbd-2021/data-input-sources ). The search criteria, including sex, age group, time range (1990–2021), and location (21 GBD regions, five SDI region groups, and 204 countries), were set according to the needs of each part of the study to query incidence rates, numbers of DALYs, death rates, age-standardized incidence rate (ASIRs), age-standardized DALY rate(ASDRs), and age-standardized mortality rate༈ASMRs༉ to estimate the burden level and temporal trends of MM. This study adhered to the Guidelines for Accurate and Transparent Health Estimates Reporting (GATHER). This study used publicly available data from the GHDx query tool without identifiable information and was considered exempt from review by the University of Toledo Institutional Review Board. Statistical analyses We used the estimated annual percentage change (EAPC) to quantify the dynamic trend of the global MM burden from 1990 to 2021. In short, we used a regression line model to describe these data. The annual average ASR (age standardized rate) growth rate was fitted using a natural logarithmic model, i.e., y = α + βx + ɛ, where y = ln (ASR) and x is the calendar year. The estimated EAPC of the ASR was 100×(exp(β)-1), and the 95% confidence interval (CI) was calculated. To predict the incidence and mortality rates for the next 20 years, a Bayesian age-period-cohort (BAPC) model was used with default parameters, for studying the multiplier effects of age, period, and cohort: η ij = µ + α i + β j + γ k . In this model, η ij represents the ASR, µ represents the intercept, α i and γ k represent the age and cohort effects, respectively [ 14 ]. All the statistical data analyses and graphing were performed using the R programming language (V4. 4. 0) and JD-GBDR (V2.14, China). A two-sided p value < 0.05 was considered to indicate statistical significance. Results 1. Main findings Table 1 shows that the number of MM cases worldwide in 2021 was 303,104.6 (95% UI: 318,904.8-281,717.6), with an ASIR was 3.6 (95% CI: 3.7-3.3) per 100,000 people. In 1990, the estimated global incidence of melanoma for all age groups was 1,243,199.8 (95% UI: 1,276,610.5-1,196,033.9), with an ASIR of 3 (95% CI: 3.1-3) per 100,000 people. The EAPC of the ASIR from 1990 to 2021 was 0.6% (95% CI: 0.3-1.0%). Table 1: Incidence, ASIRs, and EAPCs of malignant melanoma globally and in 5 regions with different SDI scores and 21 GBD regions in 1990 and 2021 1990 2021 1990-2021 Incidence (No. cases) (95% UI) ASIR per 100,000 people (95% CI) Incidence (No. cases) (95% UI) ASIR per 100,000 people (95% CI) EAPC of the ASIR (95% CI) Global Both sexes 124,319.8 (127,610.5-119,603.9) 3 (3.1-2.9) 303,104.6 (318,904.8-281,717.6) 3.6 (3.7-3.3) 0.6 (0.3-1.0) Male 61,693.1 (63,465.5-59,289.8) 3.2 (3.3-3.1) 161,315.9 (171,042.7-150,889.9) 4.1 (4.4-3.8) 0.9 (0.5-1.3) Female 62,626.7 (64,845.3-59,679.9) 2.8 (2.9-2.7) 141,788.8 (153,060-130,334.8) 3.2 (3.4-2.9) 0.4 (0.1-0.7) SDI High 93,901.9 (95,913.8-91,263.6) 9 (9.2-8.7) 204,511.2 (212,086.9-191,891) 11.4 (11.7-10.8) 0.7 (0.3-1.1) High-middle 21,284.6 (22,131.7-20,059.4) 2.1 (2.2-2) 64,796.4 (69,920.9-57,763.5) 3.5 (3.8-3.1) 1.7 (1.5-1.9) Low 1,428.3 (1,816.5-913.4) 0.5 (0.7-0.4) 3,942.4 (5,179.4-2,371.7) 0.6 (0.8-0.4) 0.4 (0.3-0.5) Low-middle 2,026.5 (2,539.3-1,474.5) 0.3 (0.4-0.2) 7,126 (8,762.7-4,900.2) 0.5 (0.6-0.3) 1.4 (1.3-1.4) Middle 5,558.4 (6,324.9-4,233.7) 0.5 (0.6-0.4) 22,390.9 (26,455.3-16,319.7) 0.8 (1-0.6) 1.8 (1.7-1.8) 21 regions Andean Latin America 197.4 (256-152.3) 0.9 (1.2-0.7) 889.0 (1,143.4-679.2) 1.5 (1.9-1.1) 1.7 (1.5-1.8) Australasia 6,723.4 (7,113.4-6,333.3) 29.5 (312.2-27.8) 15,279.1 (16,829.2-13,732.3) 32.4 (35.175-29.599) 0.5 (-0.0-1.0) Caribbean 188.4 (210.4-172.8) 0.7 (0.8-0.6) 593.4 (680.6-518.7) 1.1 (1.3-1) 1.2 (0.9-1.4) Central Asia 541.2 (591.4-496.4) 1.1 (1.2-1.0) 924.7 (1,059.2-821.3) 1.1 (1.2-1) -0.3 (-0.7-0.1) Central Europe 5,051.1 (5,504.2-4,797.2) 3.5 (3.8-3.3) 14 ,587.7 (16,008.4-13,107.2) 7.7 (8.4-6.9) 2.8 (2.5-3.0) Central Latin America 615.6 (632.5-598.1) 0.7(0.7-0.7) 3,521 (3,901.5-3,139.2) 1.4 (1.5-1.2) 2.1 (1.9-2.3) Central Sub-Saharan Africa 121.3 (186.1-87) 0.5 (0.8-0.4) 379.5 (605.7-252.8) 0.6 (0.9-0.4) 0.7 (0.5-0.9) East Asia 3,396.5 (4,276.1-2,231.4) 0.4 (0.5-0.2) 13,830.8 (18,381.1-7,571.1) 0.7 (0.9-0.4) 2.2 (2.0-2.4) Eastern Europe 6,987.6 (7,414.7-6,679.5) 2.6 (2.8-2.5) 19,495 (21,098.5-17,958.4) 6.3 (6.8-5.8) 2.9 (2.7-3.1) Eastern Sub-Saharan Africa 886.2 (1,107.8-582.6) 1 (1.2-0.7) 2,524.4 (3,627.6-1,453.8) 1.1 (1.6-0.7) 0.3 (0.2-0.4) High-income Asia Pacific 1,752.5 (1,865-1,630.7) 0.9(0.9-0.8) 6,107.9 (6,843.5-5,146.5) 1.8 (2-1.5) 2.4 (2.0-2.8) High-income North America 56,185.3 (57,369.9-54,303.8) 17.1 (17.5-16.6) 97,139.1 (100,890.6-91,218.2) 16.6 (17.2-15.7) -0.2 (-0.6-0.3) North Africa and Middle East 1,745.8 (2,482.5-899.3) 0.9 (1.3-0.5) 10,414.4 (12,844.1-5,662.2) 2.2(2.7-1.2) 2.9 (2.8-2.9) Oceania 9.2 (16.4-6.3) 0.3 (0.6-0.2) 23.9 (38.4-16.4) 0.3 (0.5-0.2) -0.0 (-0.0-0.0) South Asia 1,470.2 (1,955.6-1,032.5) 0.2 (0.3-0.2) 5 ,390.8 (7,543.0-3,472.4) 0.3 (0.5-0.2) 1.2 (1.1-1.4) Southeast Asia 515.1(731.2-400.5) 0.2 (0.3-0.1) 1,581.9 (2,124-1,089.3) 0.2 (0.3-0.2) 0.8 (0.7-0.8) Southern Latin America 684.3 (718.2-651.2) 1.5 (1.5-1.4) 2,472.7 (2,647.8-2,317.6) 3 (3.2-2.8) 2.1 (1.7-2.6) Southern Sub-Saharan Africa 410.4 (552.1-301.5) 1.4 (1.8-1) 1,221.3 (1,555.7-722.3) 2 (2.4-1.1) 1.3 (1.2-1.4) Tropical Latin America 1,305.4 (1,353.6-1,260.9) 1.3 (1.3-1.2) 4,947.6 (5 ,185-4 68.9) 1.9 (2-1.8) 1.2 (1.1-1.4) Western Europe 35,074.4 (36,115.4-33,846.3) 7 (7.2-6.8) 100,441.7 (105,087.2-94,012.4) 13.7 (14.2-13.1) 2.5 (2.0-2.9) Western Sub-Saharan Africa 458.5 (625.3-228.3) 0.5 (0.6-0.2) 1,338.8 (1,903.6-516.8) 0.6 (0.8-0.2) 0.5 (0.4-0.6) Abbreviations: SDI, sociodemographic index; ASIR, age-standardized incidence rate; UI, uncertainty interval; CI, confidence interval; EAPC, estimated annual percentage change Table 2 shows that the number of DALYs for individuals with MM worldwide in 2021 was 1,678,836 (95% UI: 1,837,369-1,474,534), with an ASDR of 19.6 (95% CI: 21.5-17.2) per 100,000 people. In 1990, the estimated global number of DALYs for MM patients of all ages was 10,457,77.5 (95% UI: 11,038,449-9,593,733.2), with an ASDR of 24.3 (95% CI: 25.6-22.4) per 100,000 people. The EAPC of the ASDR from 1990 to 2021 was -0.7% (95% CI: -0.8-0.5%). Table 2: DALYs, ASDRs, and EAPCs for malignant melanoma globally and in 5 regions with different SDI scores and 21 GBD regions in 1990 and 2021 1990 2021 1990-2021 No. of DALYs (95% UI) ASDR per 100 000 people (95% CI) No. of DALYs (95% UI) ASDR per 100 000 people (95% CI) EAPC of the ASDR (95% CI) Global Both sexes 1,045,777.5 (1,103,849-959,373.2) 24.3 (25.6-22.4) 1,678,836 (1,837,369-1,474,534) 19.6 (21.5-17.2) -0.7 (-0.8--0.5) Male 576,637.9 (617,161.4-517,184.3) 28.1(30-25.3) 942,404.4 (1,056,864-822,097.6) 23.2 (26-20.3) -0.5 (-0.7—0.4) Female 469,139.6 (517,864.3-420,903.4) 21.0 (23.2-18.9) 736,431.9 (851,312.3-615,594.7) 16.6 (19.2-13.8) -0.8 (-0.9--0.7) SDI High 553,624.1 (572,213.2-536,872.7) 53.4 (55.2-51.9) 725,831.6 (769,618.4-682,352.4) 41 (43.4-38.9) -0.7 (-0.8--0.5) High-middle 264,662.8 (278,416.1-242,600.8) 25.5 (26.8-23.4) 428,049.8 (463,677-378,977.6) 23.3 (25.2-20.6) -0.3 (-0.5--0.2) Low 42,672.6 (54,250.8-27,239.4) 14.8 (18.7-9.5) 100,368.2 (134,250.3-59,920.9) 14.6 (19.3-8.8) -0.2 (-0.2--0.1) Low-middle 54,546.5 (68,759.3-39,683.5) 7.3 (9.2-5.4) 140,995.4 (179,625.6-96,861) 8.5 (10.9-5.9) 0.5 (0.5-0.5) Middle 128,660.5(148,647-97,135.4) 10.4 (12.1-8) 281,236.8(329,491.2-209,527.5) 10.3 (12-7.7) -0.1 (-0.2--0.1) 21 regions Andean Latin America 4,666.9 (6,171.7-3,556.4) 20.3 (26.7-15.4) 12,219.3 (15,679.1-9,210.9 20 (25.5-15.1) 0.0 (-0.1-0.1) Australasia 44,593.7 (47,089.8-42,040.6) 196 (207.0-184.8) 51,338.5 (56,880-46,475.2) 110 (120.6-100.6) -1.8 (-2.2--1.4) Caribbean 3,394 (2,973.7-4,097.4) 12.1 (14.5-10.7) 7,359.7 (9,020.1-6,180.3) 13.9 (17.1-11.6) 0.2 (-0.0--0.4) Central Asia 9,956.2 (10,884.7-9,134.8) 19.6 (21.4-17.9) 12,833.1 (14,829.2-11,102.4) 14.8 (17.0-12.9) -1.3 (-1.6--1.0) Central Europe 75,339.7 (81,349.7-71,227.9) 52.5 (56.7-49.6) 108,838 (118,197.9-98,914.4) 58.3 (63.5-52.8) -1.3 (-1.6--1.0) Central Latin America 13,483.7 (13,827.4-13,145.1) 13.5 (13908-13.2) 46,904 (51,763.9-42,082.3) 18.2 (20.1-16.3) 0.7 (0.6-0.8) Central Sub-Saharan Africa 3,599 (5,508.1-2,564.8) 13 (20-9.3) 9,933.1 (16,194.1-6,666.3) 13.9 (22-9.1) 0.3 (0.2-0.4) East Asia 92,402.9 (114,970.2-58,181.5) 9 (11.3-5.9) 160,829.5 (212,715.7-89,349) 7.9 (10.4-4.4) -0.5 (-0.6--0.3) Eastern Europe 99,534.4 (105,417.7-95,372.9) 37.7 (40-36.1) 164,701.2 (180,397-150,656.8) 54 (59.2-49.2) 1.0 (0.7-1.3) Eastern Sub-Saharan Africa 27,117.9 (34,250-17,681.8) 27 (33.9-17.8) 67,196.8 (96,675.4-38,352) 27 (38.1-15.6) -0.1 (-0.2--0.1) High-income Asia Pacific 13 864.7 (14 935.6-12 586) 6.9 (7.5-6.3) 23,622.8 (26,422.9-20,041.7) 6.9 (7.7-5.8) 0.0 (-0.2-0.2) High-income North America 254,121.9 (263,281-245,110.8) 78.8 (81.7-76.1) 292,143.4 (310,795-274,912.2) 51.1 (54.1-48.2) -1.4 (-1.6--1.1) North Africa and Middle East 17,510.6 (26,204.9-8,479.8) 9 (13.1-4.5) 375 59 (45,928.6-19,940.4) 7.6 (9.3-4) -0.6 (-0.7--0.5) Oceania 271.2 (482.6-182.8) 8 (14.3-5.5) 691 (1,104.1-469.1) 7.9 (12.7-5.5) 0.0 (0.0-0.0) South Asia 42,751.5 (57,680.7-30,022.9) 5.8 (7.8-4.1) 108,847.8 (151,823.3-72,708.3) 6.4 (8.9-4.3) 0.2 (0.2-0.3) Southeast Asia 15,260.1 (21,599.8-11,475.5) 4.9 (7-3.8) 37,794.3 (50,051-26,157.6) 5.4 (7.1-3.7) 0.2 (0.2-0.3) Southern Latin America 12,050.9 (12,629.7-11,410.3) 25.8 (27-24.4) 24,482.3 (26,192.2-23,023.2) 29.9 (32-28.1) 0.4 (-0.0-0.8) Southern Sub-Saharan Africa 9,818.7(13,487.9-7,396.6) 34.5 (41.4-22.4) 25,073.0 (32,363.8-15,225.4) 37.6 (47.4-22.6) 0.8 (0.7-1.0） Tropical Latin America 29,819 (30,803.3-28,860.2) 27 (28-26.1) 70,160.4 (73,106.6-66,555.4) 27 (28.1-25.6) -0.1 (-0.3-0.0） Western Europe 262,977.7 (270,867-254,028) 53.4 (54.9-51.8) 383,503.1 (407,460.3-357,556) 52.6 (55.6-49.7) 0.2 (-0.0-0.4） Western Sub-Saharan Africa 13,243.2 (18,321.2-6,417.3) 12.3 (16.9-6.1) 32,805.8 (46,376.8-12,756.6) 12.2 (16.9-5.1) -0.1 (-0.--0.0） Abbreviations: DALYs, disability-adjusted life years Table 3 shows that the number of deaths of MM worldwide in 2021 was 61,549 (95% UI: 66,265-54,852.5), with an ASMR of 0.7 (95% CI: 0.8-0.7) per 100,000 people. In 1990, the estimated global number of deaths due to melanoma for all age groups was 33,061 (95% UI: 34,529.5-30,546.4), with an ASMR of 0.8 (95% CI: 0.9-0.8) per 100,000 people. The EAPC of the ASMR from 1990 to 2021 was -0.4% (95% CI: -0.6%-0.3%). Table 3: Number of deaths, ASMRs, and EAPCs for malignant melanoma globally and in 5 regions with different SDI scores and 21 GBD regions in 1990 and 2021 1990 2021 1990-2021 No. of deaths (95% UI) ASMR per 100,000 people (95% CI) No. of deaths (95% UI) ASMR per 100,000 people (95% CI) EAPC of the ASMR (95% CI) Global Both sexes 33,061 (34,529.5-30,546.4) 0.8 (0.9-0.8) 61,549 (66,265-54,852.5) 0.7 (0.8-0.7) -0.4 (-0.6--0.3) Male 17,764.1 (18,875-16,089.9) 1 (1.1-1) 34,322.0 (37,624.8-30,494.4) 0.9 (1-0.8) -0.2 (-0.4--0.0) Female 15,296.8 (16,776-13,840.2) 0.7 (0.8-0.7) 27,227.7 (30,950.5-23,212.2) 0.6 (0.7-0.5) -0.7 (-0.8--0.6) SDI High 18,038.1 (18,488.8-17,378.4) 1.7 (1.7-1.6) 28,891.9 (30,286.7-531.4) 1.4 (1.5-1.3) -0.5 (-0.7--0.3) High-middle 8,363.7 (8,747.2-7,705) 0.9 (0.9-0.8) 15,762.6 (17,010.7-14,112.1) 0.8 (0.9-0.7) -0.1 (-0.3-0.0) Low 1,198.8 (1,517.8-773.1) 0.5 (0.6-0.3) 2,743.8 (3,616.7-1,656.2) 0.5 (0.6-0.3) -0.2 (-0.2--0.1) Low-middle 1,588.9 (2,011.4-1,173.5) 0.3 (0.3-0.2) 4,284.8 (5,404.7-3,018) 0.3 (0.4-0.2) 0.5 (0.5-0.5) Middle 3,818.9 (4,445.9-2 ,940.1) 0.4 (0.4-0.3) 9,773.3 (11,254.1-7,341.2) 0.4 (0.4-0.3) -0.0 (-0.1-0.0) 21 regions Andean Latin America 164.2 (213-126.1) 0.8 (1-0.6) 481 (604.1-361.8) 0.8 (1-0.6) 0.2 (0.0-0.3) Australasia 1,507.3 (1,611.4-1,409.8) 6.5 (7-6.1) 2,072.8 (288.4-1,842.1) 3.9 (4.3-3.5) -1.6 (-2.0--1.2) Caribbean 113.3 (132.8-100.9) 0.4 (0.5-0.4) 270.6 (318.2-233.2) 0.5 (0.6-0.4) 0.2 (-0.0-0.4) Central Asia 339.3 (372.2-308) 0.7 (0.8-0.7) 453.4 (516.3-397.3) 0.6 (0.7-0.5) -1.0 (-1.3--0.7) Central Europe 2,448.2 (2,650.5-2,309.6) 1.7 (1.9-1.6) 4,454.1 (4,814.8-4,065.9) 2.1 (2.3-1.9) 0.8 (0.6-0.9) Central Latin America 431.9 (443.8-418.7) 0.5 (0.5-0.5) 1,715.9 (1,890.8-1,534.1) 0.7(0.8-0.6) 0.7 (0.6-0.8) Central Sub-Saharan Africa 105.8 (162.2-76.3) 0.5 (0.7-0.3) 289 (460.2-190.9) 0.5 (0.8-0.3) 0.4 (0.3-0.5) East Asia 2,680.8 (3,420.3-1,785) 0.3 (0.4-0.2) 5,646.9 (7,410.3-3,090.4) 0.3 (0.4-0.2) -0.4 (-0.5--0.4) Eastern Europe 3,037.9 (3,213.2-2,910) 1.1 (1.2-1.1) 5,744.4 (6,249.7-5,269.1) 1.7 (1.9-1.6) 1.2 (1.0-1.4) Eastern Sub-Saharan Africa 741.3 (929.5-488.8) 0.9 (1.1-0.6) 1,762.2 (2,472.3-1,017.3) 0.9 (1.2-0.5) -0.1 (-0.2--0.1) High-income Asia Pacific 459.1 (490.9-422) 0.2 (0.3-0.2) 1,048.5 (1,178.4-870.1) 0.2 (0.3-0.2) -0.1 (-0.2-0.1) High-income North America 7,836.9 (8,017.9-7,497.7) 2.3 (2.4-2.2) 11,152.1 (11,647.8-10,293.6) 1.7 (1.8-1.6) -0.9 (-1.1--0.6) North Africa and Middle East 556.6 (804.6-279.8) 0.4 (0.5-0.2) 1,237.8 (1,510.8-635.9) 0.3 (0.4-0.2) -0.5 (-0.6--0.4) Oceania 8.6 (15.4-5.8) 0.3 (0.6-0.2) 22.3 (35.8-15.4) 0.3 (0.5-0.2) -0.1 (-0.1--0.0) South Asia 1,186.6 (1,589.3-844.9) 0.2 (0.3-0.1) 3,241.9 (4,484.2-2,513.1) 0.2 (0.3-0.14) 0.3 (0.2-0.4) Southeast Asia 453.2 (6545.2-351.1) 0.2 (0.2-0.1) 1,255.7 (1,657.8-863.7) 0.2 (0.3-0.1) 0.4 (0.3-0.4) Southern Latin America 404.4 (422.1-383.2) 0.9 (0.9-0.8) 917.1 (980.9-852.9) 1.1 (1.1-1) 0.5 (1.0-0.9) Southern Sub-Saharan Africa 305.6 (408.7-218.9) 1.1 (1.5-0.8) 794.3 (986-470) 1.4 (1.7-0.8) 0.8 (0.7-1.0) Tropical Latin America 878.8 (911.7-847.6) 0.9 (1-0.9) 2,499.2 (2,629.5-2,317.9) 1 (1-0.9) 0.2 (0.0-0.3) Western Europe 9,011.1 (9,261.7-8,649.8) 1.7 (1.7-1.6) 15,566 (16,443.2-14,023.1) 1.7 (1.8-1.6) 0.3 (0.2-0.5) Western Sub-Saharan Africa 390 (532.8-198.6) 0.4 (0.6-0.2) 924.5 (1,273.9-387.2) 0.4 (0.6-0.2) 0.0 (-0.0-0.1) Abbreviations: ASMR, age-standardized mortality rat 2. Geographical Differences Figure 1 shows the distributions of the global ASIRs, ASDRs, and ASMRs among MM patients in 1990 and 2021. Figure 1(A) and (B) show the countries with the highest ASIRs in 2021 were Australia, Italy, France, Germany, Austria, the Czech Republic, the United Kingdom (UK), Ireland, Sweden, Finland, Iceland, and the United States (US). The countries with the highest ASIRs in 1990 were the US, Canada, Australia, and New Zealand. Figure 1(C) and (D) show the countries with the highest ASDRs in 2021 were Australia, New Zealand, Namibia, Zimbabwe, Sweden, Finland, Norway, Poland, the Czech Republic, Austria, the UK, and Iceland. The countries with the highest ASDRs in 1990 were Australia, the US, Canada, Finland, Sweden, and Norway. Figure 1(E) and (F) show the countries with the highest ASMRs in 2021 were Australia, New Zealand, Namibia, Zimbabwe, North Macedonia, Croatia, Slovenia, Austria, the Czech Republic, Poland, Latvia, Estonia, Norway, Sweden, Finland, the UK, and the Netherlands. The countries with the highest ASMRs in 1990 were Australia, New Zealand, Namibia, the Czech Republic, Austria, Hungary, Croatia, Serbia, Norway, Sweden, and the US. Figure 1 . Global distribution of the ASIR, ASDR, and ASMR of malignant melanoma in 1990 and 2021 (A) Worldwide distribution of malignant melanoma ASIRs in 1990 (B) Worldwide distribution of malignant melanoma ASIRs in 2021 (C) Worldwide distribution of malignant melanoma ASDRs in 1990 (D) Worldwide distribution of malignant melanoma ASDRs in 2021 (E) Worldwide distribution of malignant melanoma ASMRs in 1990 (F) Worldwide distribution of malignant melanoma ASMRs in 2021 Figure 2 shows social development levels of 204 GBD countries and their corresponding ASIRs, ASDRs, and ASMRs of MM in 2021. Figure 2(A) shows that the five countries with the highest MM ASIRs from highest to lowest were New Zealand (38.9%, 95% CI: 42.4-35.2), Australia (31.2%, 95% CI: 34.2-28.2), Norway (23, 95% CI: 24.8-21.2), the Netherlands (21.6%, 95% CI: 23.2-19.7), and Denmark (19.7%, 95% CI: 21.4-17.9). Figure 2(B) shows that the five countries with the highest MM ASDRs from highest to lowest were New Zealand (124.6%, 95% CI: 135.2-113.1), Australia (107.2%, 95% CI: 118.4-97.3), Norway (94.6%, 95% CI: 101.4-88.4), North Macedonia (86.9%, 95% CI: 122.7-50.6), and the Netherlands (80.9%, 95% CI: 87.4-74.7). Figure 2(C) shows that the five countries with the highest MM ASMRs from highest to lowest were New Zealand (4.3%, 95% CI: 4.7-3.9), Australia (3.8%, 95% CI: 4.2-3.4), Norway (3.4%, 95% CI: 3.6-3.1), North Macedonia (3.3%, 95% CI: 4.4-2), and Namibia (2.9%, 95% CI: 4.5-1.9). Figure 2 . Social development levels of the 204 GBD countries in 2021 and the corresponding ASIRs, ASDRs, and ASMRs of malignant melanoma. (A) ASIRs (B) ASDRs (C) ASMRs 3. Temporal trends Figure 3 shows the temporal trends in MM burden from 1990 to 2021 globally and in five regions with different SDI scores. Figure 3(A) relevels the global EAPC of the high-middle-SDI regions was the highest, at 1.9% (95% CI: 1.6%-2.1%). The next highest EAPC was that of the high-SDI regions, at 0.8% (95% CI: 0.4-1.2%). ASIRs among women in high-middle-SDI regions were greater than those of men in all study years. In Figure 3(B), the global ASDR of the high-SDI regions decreased the most, with EAPCs of -0.7%（95% CI: -0.8--0.5）. The next highest ASDR was that of the high-middle-SDI regions (-0.3% (95% CI: -0.5-0.2%)). In Figure 3(C), the global ASMR of the high-SDI regions decreased the most, with an EAPC of -0.5% (95% CI: -0.7-0.3%), while the low-middle-SDI regions increased the most, with an EAPC of 0.5% (0.5-0.5%). The ASMRs among women in high-middle-SDI regions were greater than those among men in all study years. Figure 3 . Age-standardized incidence rates, age-standardized DALYs, and age-standardized mortality rates among malignant melanoma patients in five regions with different SDI scores, globally, and by sex from 1990 to 2021, with time trends (A) Age-standardized incidence rates (B) Age-standardized DALYs (C) Age-standardized mortality rates Figure 4 shows the temporal trends of the annual ASIRs, ASDRs, and ASMRs for MM in 21 GBD regions from 1990 to 2021. Figure 4(A) shows that the ASIRs in Australia, high-income North America, and Western Europe increased and then decreased over the past 31 years, but the morbidity levels remained relatively high. In contrast, the ASIRs in Eastern Europe, Central Europe, and Central Asia gradually increased over the past 31 years. Overall, high morbidity still exists in countries with high SDI scores. Figure 4(B) shows that the ASDRs in Australia and high-income North America decreased over time, with Australia having the highest ASDR among all regions. The ASDR in Western Europe first increased and then decreased. Overall, a high ASDR was still observed in countries with high SDI scores, but the ASDR markedly decreased with increasing SDI scores. Figure 4(C) shows that although the ASMR in Australia decreased continuously over the past 31 years, it was still the highest among all regions in 2021. The ASMRs in high-income North America, Western Europe, and southern Latin America showed an upwards trend followed by a downwards trend. Overall, a high ASMR was still observed in regions with high SDI scores, but the ASMR mortality rate markedly decreased with increasing SDI scores. Figure 4 . Time trends of social development levels and the corresponding ASIRs, ASDRs, and ASMRs of malignant melanoma in 21 GBD countries from 1990 to 2021 (A) ASIRs (B) ASDRs (C) ASMRs 4. Age and gender distribution patterns Figure 5 shows the estimated global ASIR, ASDR, and ASMR distributions and trends by age and gender. Figure 5(A) and (B) show that the incidence rate of MM among female patients aged 15-49 years was higher than that among male patients worldwide in 2021, while the incidence rate among male patients aged 55-89 years surpassed that among female patients. For female patients, the ASIR increased with age globally. Among male patients, the incidence rate increased before the age of 90 and decreased after. Figure 5(C) and (D) show that in 2021, the disability rate was higher among female patients aged 15-29 worldwide than male patients, while it was higher among male patients aged 30-89 than female patients. The disability rate of female patients increased with age, whereas for male patients it increased before the age of 94 and decreased after that. In 1990, the disability rate among female patients aged 20-29 worldwide exceeded that of male patients, while for those aged 30-74 it was higher in males than females. Both genders' disability rates increased with age in 1990. Figure 5(E) and (F) show that in 2021, ASMR rates increased with age for both females and males worldwide. Among those aged 15-29, females had higher ASMR rates than males, while among those aged 30-89, males had higher rates than females; and among those aged 90 or older, females had higher rates than males. In 1990, ASMR rates also increased with age for both genders. Figure 5 . Distribution characteristics and trends of the global ASIR, ASDR, and ASMR among malignant melanoma patients by age group and sex in 1990 and 2021 (A) Global distribution of the ASIRs of MM in 1990 (B) Global distribution of the ASIRs of MM in 2021 (C) Global distribution of the ASDRs of MM in 1990 (D) Global distribution of the ASDRs of MM in 2021 (E) Global distribution of the ASMRs of MM in 1990 (F) Global distribution of the ASMRs of MM in 2021 Error bars indicate the 95% UIs for the global ASIRs, ASDRs, and ASMRs. 5. Forecasts for the forthcoming two decades Figure 6 shows the incidence of MM in the next 20 years is expected to remain stable, with a slight downward trend, while the mortality rate is anticipated to decline significantly. Figure 6 . Predicted age-standardized incidence and mortality rates of malignant melanoma over the next 20 years (A) Age-standardized incidence rate (B) Age-standardized mortality rate Discussion Our main findings were as follows: (1) The global incidence rate of MM increased from 1990 to 2021, while the ASDR and ASMR decreased during the same period. （2）The highest ASIR, ASDR, and ASMR was observed in high-SDI countries. (3) Australia remained the region with the highest ASIR, ASDR, and ASMR. (4) older adult males, particularly those over the age of 50, should intensify efforts in the prevention and management of MM. (5) The incidence of MM is predicted to remain stable over the next 20 years, while the mortality rate will significantly decline. The increasing trend in the global incidence of MM from 1990 to 2021 can be attributed to demographic aging and improved detection rates. The high incidence rate of MM in regions with high socio-demographic index (SDI) may be linked to a higher proportion of individuals with reduced skin pigmentation and increased susceptibility to ultraviolet radiation [15]. Furthermore, the notable EAPCs observed in middle-SDI regions, Western Europe, the Middle East, and South Africa underscore the need for enhanced preventive measures. Notably, Australia, New Zealand, the US, and European countries exhibited the highest ASIRs in 2021; however, their declining trends could be associated with proactive interventions such as self-examination practices, public education initiatives, and advancements in multitherapy options over recent decades. Moreover, northern US regions demonstrated relatively high incidence and prevalence rates of MM warranting intensified prevention efforts [16]. It is noteworthy that only about 40% of Americans report adherence to recommended sun protection measures [17]. For the DALYs of MM, the global average decreased continuously from 1990 to 2021. Both high-SDI regions and low-middle-SDI regions need more prevention and control of MM-related disabilities as the former had a higher-level ASDR and the latter has been increasing in ASDR. Nationally, New Zealand, Australia, and Norway were among the three countries with the highest age-standardized DALYs. A retrospective cohort study utilized the U.S. administrative claims database (Truven Health MarketScan®) to determine the incidence, timing, and cost of short-term disability (STD) and long-term disability (LTD) among adult patients with advanced melanoma. The study identified 1,052 patients with a late-stage melanoma diagnosis between 2011 and 2012, of whom 14 and 9 transitioned to STD and LTD, respectively. During the STD period, the average number of treatment days (from the start of treatment to the date of drug supply end or expected clinical benefit) was 16.4 days for patients receiving treatment, and 25.1 days for patients not receiving treatment. Among the 14 STD and 5 LTD patients with return-to-work records, the average time to return to work was 85.6 days and 76.4 days, respectively [18]. The reduction in DALYs may be due to increased awareness of prevention and treatment, improved care quality, and the widespread use of innovative drugs. A study found that the overall quality care index (QCI) for melanoma has increased from 82.81 in 1990 to 91.29 in 2019. There is a positive correlation with socioeconomic status, with higher QCI scores. Australia has the highest QCI score (99.96), while the Central African Republic and Kiribati have the lowest. There has been a significant improvement in QCI for China and Saudi Arabia, while QCI has declined in North Korea, Zimbabwe, and Guam from 1990 to 2019[19]. According to a European study from 2017 to 2018, the report found that 19 countries (55.8%) fully reimbursed the recommended BRAFi + MEKi combination therapy and anti-PD1 immunotherapy for melanoma treatment, while 17 countries (50%) fully covered the combination of anti-CTLA4 + anti-PD1 therapy. The study also reflects the relationship between global accessibility of innovative drugs for advanced melanoma treatment and economic and healthcare system performance [20]. The global ASMR of MM decreased continuously from 1990 to 2021. Compared with previous studies, Yuan Jin et al. [21] reported that the total mortality rate of MM globally decreased from 1990 to 2019. The mortality rate of people under 77.5 years old also decreased. A European study, including data from 123,360 cases of aggressive melanoma, found that death rates were generally declining in most European countries, with a few exceptions [22]. The observed trend of decreasing mortality rates among MM patients in certain countries is consistent with the findings of this study. The US has experienced a significant decrease in both the ASDR and ASMR, which may be due to the approval of 10 new targeted or immunotherapy drugs since 2011[23]. Australia's primary prevention measures, such as providing education on sun protection, have increased the use of sunscreen and may curbed death rates of MM since 1988[3]. Regarding sex and age differences, for women, ASIR, ASDR, and ASMR all increased with age; for men, ASIR, ASDR, and ASMR increased with age, but after reaching a certain age, the ASIR (>85 years) and ASDR (>90 years) tended to stabilize or decrease. Compared with previous reports, Urban Katelyn et al. [24] revealed that the incidence of MM in females was greater before the age of 50 years, and the trend reversed from the age of 50 to 85 years. Male mortality was greater at all ages. Raimondi et al. [25] reported the incidence rate of MM is greater among teenagers and young women than among men. The incidence rate reversed at the age of 40 years, with the incidence of melanoma in males being greater than that in females. Buja et al. [26] reported that MM is more common in young adult women and older adult men. The standardized incidence rate of females was greater than males before the age of 50 years and after the age of 90 years. Zhang et al. [27] reported the ASR of the skin cancer burden among males was greater than that among females. The age-specific rate of the global skin cancer burden was greater in the elderly population, and an upwards trend was observed in the 55 years+ age group. These findings exhibited variability, yet consistently suggested that older adult males, particularly those over the age of 50, should intensify efforts in the prevention and management of MM. The limitations of this study are as follows: (1) The absence of disease burden data related to MM subtypes or its risk factors in GBD 2021 impedes a comprehensive understanding of the contributors to MM and hampers the development of targeted and effective measures for prevention and control. (2) GBD 2021 employs sophisticated statistical models for estimating disease burden, introducing potential uncertainties in assumptions and parameter selection that may impact the accuracy and reliability of estimated results. (3) Regional variations in cancer registration practices may lead to underreporting of MM. Conclusion In summary, this study revealed that the global ASIR of MM increased from 1990 to 2021, accompanied by a decrease in the ASDR and ASMR during the same period. High-SDI countries such as Australia and New Zealand, high-income North America, some European countries remain higher in ASIR, ASDR, and ASMR. It is imperative for older adult males to intensify efforts in preventing and controlling MM. Declarations Competing interests: the authors declare no potential conflicts of interest. Patient consent Not applicable. Funding Source: This work was supported by Anhui Provincial Key Research and Development Program Project (202104j07020048). Author Contribution Ling Yao, Huashang Li, Guixiang Qian contributed equally to this work and are joint senior authors. Xiaoqiang Jia conceived and designed the study. Longfang Quan and Xuedi Lei supervised the study. Jie Dai and Qiuling Liu performed the statistical analysis. All authors contributed to the acquisition, analysis, or interpretation of data. Ling Yao, Huashang Li, Guixiang Qian and Zhuhui Zhang drafted the manuscript. All authors revised the report and approved the final version before submission. Yonghai Li is the guarantor and attests that all listed authors meet authorship criteria and that no others meeting the criteria have been omitted. Data Availability Data is provided within the manuscript or supplementary information files. References Lopes, J., Rodrigues, C. M., Gaspar, M. M. & Reis, C. P. Melanoma management: from epidemiology to treatment and latest advances. Cancers.;14:4652. (2022). https://doi.org/10.3390/cancers14194652 Long, G. V., Swetter, S. M., Menzies, A. M., Gershenwald, J. E. & Scolyer, R. A. Cutaneous melanoma. Lancet 402 , 485–502. 10.1016/S0140-6736(23)00821-8 (2023). Saginala, K., Barsouk, A., Aluru, J. S., Rawla, P. & Barsouk, A. Epidemiology of melanoma. Med. Sci. 9 , 63. https://doi.org/10.3390/medsci9040063 (2021). Paulson, K. G. et al. Age-specific incidence of melanoma in the United States. JAMA dermatology . 156 , 57–64. 10.1001/jamadermatol.2019.3353 (2020). 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Res. 315 , 2893–2904. https://doi.org/10.1007/s00403-023-02730-2 (2023). Sekulovic, L. K. et al. Access to innovative medicines for metastatic melanoma worldwide: Melanoma World Society and European Association of Dermato-oncology survey in 34 countries. Eur. J. Cancer . 104 , 201–209. https://doi.org/10.1016/j.ejca.2018.09.013 (2018). Yuan, J., Li, X. & Yu, S. Global, regional, and national incidence trend analysis of malignant skin melanoma between 1990 and 2019, and projections until 2034. Cancer Control . 31 , 10732748241227340. 10.1177/10732748241227340 (2024). Sacchetto, L. et al. Skin melanoma deaths within 1 or 3 years from diagnosis in Europe. Int. J. Cancer . 148 , 2898–2905. 10.1002/ijc.33479 (2021). Berk-Krauss, J., Stein, J. A., Weber, J., Polsky, D. & Geller, A. C. New systematic therapies and trends in cutaneous melanoma deaths among US whites, 1986–2016. Am. J. Public Health . 110 , 731–733. 10.2105/AJPH.2020.305567 (2020). Urban, K., Mehrmal, S., Uppal, P., Giesey, R. L. & Delost, G. R. The global burden of skin cancer: A longitudinal analysis from the Global Burden of Disease Study, 1990–2017. JAAD Int. 2 , 98–108. 10.1016/j.jdin.2020.10.013 (2021). Raimondi, S., Suppa, M. & Gandini, S. Melanoma epidemiology and sun exposure. Acta dermato-venereologica . 100 10.2340/00015555-3491 (2020). Buja, A. et al. Sex differences in cutaneous melanoma: incidence, clinicopathological profile, survival, and costs. J. Women's Health . 31 , 1012–1019. https://doi.org/10.1089/jwh.2021.0223 (2022). Zhang, W. et al. Global, regional and national incidence, mortality and disability-adjusted life‐years of skin cancers and trend analysis from 1990 to 2019: an analysis of the Global Burden of Disease Study 2019. Cancer Med. 10 , 4905–4922 (2021). https://doi.org/10.1002/cam4.4046 Additional Declarations No competing interests reported. Supplementary Files Figure1DALYsIncidecne.csv Figure1Death.csv Figure2.csv Figure3.csv Figure4.csv Figure5.csv Figure6.csv Table13.xlsx Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {\"props\":{\"pageProps\":{\"initialData\":{\"identity\":\"rs-5813672\",\"acceptedTermsAndConditions\":true,\"allowDirectSubmit\":true,\"archivedVersions\":[],\"articleType\":\"Article\",\"associatedPublications\":[],\"authors\":[{\"id\":410951805,\"identity\":\"ddc0f725-de75-4b26-9257-f635a536688c\",\"order_by\":0,\"name\":\"Ling Yao\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Guang’anmen Hospital\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Ling\",\"middleName\":\"\",\"lastName\":\"Yao\",\"suffix\":\"\"},{\"id\":410951806,\"identity\":\"a36af38a-2274-4edc-b4ce-6aedd89056b1\",\"order_by\":1,\"name\":\"Yonghai 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Worldwide distribution of malignant melanoma ASDRs in 2021\\u003c/p\\u003e\\n\\u003cp\\u003e(E) Worldwide distribution of malignant melanoma ASMRs in 1990\\u003c/p\\u003e\\n\\u003cp\\u003e(F) Worldwide distribution of malignant melanoma ASMRs in 2021\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"image1.png\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-5813672/v1/0a0328610bbf6db5b2610141.png\"},{\"id\":75615918,\"identity\":\"0e87c819-b380-4435-b495-58c3d0a6bf5d\",\"added_by\":\"auto\",\"created_at\":\"2025-02-06 10:58:11\",\"extension\":\"png\",\"order_by\":2,\"title\":\"Figure 2\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":998355,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003eSocial development levels of the 204 GBD countries in 2021 and the corresponding ASIRs, ASDRs, and ASMRs of malignant melanoma.\\u003c/p\\u003e\\n\\u003cp\\u003e(A) ASIRs\\u003c/p\\u003e\\n\\u003cp\\u003e(B) ASDRs\\u003c/p\\u003e\\n\\u003cp\\u003e(C) 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10:50:11\",\"extension\":\"csv\",\"order_by\":7,\"title\":\"\",\"display\":\"\",\"copyAsset\":false,\"role\":\"supplement\",\"size\":839114,\"visible\":true,\"origin\":\"\",\"legend\":\"\",\"description\":\"\",\"filename\":\"Figure6.csv\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-5813672/v1/5c3d9b5b7d12e85e616519f2.csv\"},{\"id\":75617530,\"identity\":\"77b679d9-e909-4085-b37c-cebb3865d271\",\"added_by\":\"auto\",\"created_at\":\"2025-02-06 11:22:11\",\"extension\":\"xlsx\",\"order_by\":8,\"title\":\"\",\"display\":\"\",\"copyAsset\":false,\"role\":\"supplement\",\"size\":242289,\"visible\":true,\"origin\":\"\",\"legend\":\"\",\"description\":\"\",\"filename\":\"Table13.xlsx\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-5813672/v1/dd68e48ed3032b2fad7b31fa.xlsx\"}],\"financialInterests\":\"No competing interests reported.\",\"formattedTitle\":\"Epidemiological Characteristics and Temporal Trends of Malignant Melanoma from 1990 to 2021, with Projections until 2044\",\"fulltext\":[{\"header\":\"Introduction\",\"content\":\"\\u003cp\\u003eMalignant melanoma (MM), originating from melanocytes in the skin, is the deadliest form of skin cancer due to its high heterogeneity and metastasis potential.[\\u003cspan citationid=\\\"CR1\\\" class=\\\"CitationRef\\\"\\u003e1\\u003c/span\\u003e] MM is widely attributed to natural sunlight exposure and indoor tanning-induced ultraviolet radiation[\\u003cspan citationid=\\\"CR2\\\" class=\\\"CitationRef\\\"\\u003e2\\u003c/span\\u003e]. Globally, MM accounts for 1.7% of all diagnosed cancers and ranks as the fifth most common cancer in the United States. Since 1975, there has been a more than 320% increase in MM incidence in developed predominantly white countries [\\u003cspan citationid=\\\"CR3\\\" class=\\\"CitationRef\\\"\\u003e3\\u003c/span\\u003e\\u0026ndash;\\u003cspan citationid=\\\"CR4\\\" class=\\\"CitationRef\\\"\\u003e4\\u003c/span\\u003e]. Annually, MM causes over 20,000 deaths in Europe with a continuing rise in incidence, resulting in an estimated 325,000 new cases and 57,000 deaths globally in 2020[\\u003cspan citationid=\\\"CR5\\\" class=\\\"CitationRef\\\"\\u003e5\\u003c/span\\u003e]. Projections indicate that by 2040, there will be approximately 516,000 new cases and 96,000 deaths annually due to MM [\\u003cspan citationid=\\\"CR6\\\" class=\\\"CitationRef\\\"\\u003e6\\u003c/span\\u003e]. The projected annual cost of treating newly diagnosed MM is expected to escalate from \\u003cspan\\u003e$\\u003c/span\\u003e457\\u0026nbsp;million in 2011 to \\u003cspan\\u003e$\\u003c/span\\u003e1.6\\u0026nbsp;billion by 2030 [\\u003cspan citationid=\\\"CR7\\\" class=\\\"CitationRef\\\"\\u003e7\\u003c/span\\u003e].\\u003c/p\\u003e \\u003cp\\u003eThe distribution of MM exhibits regional disparities. Australia and Aotearoa New Zealand reported the highest incidences [\\u003cspan citationid=\\\"CR8\\\" class=\\\"CitationRef\\\"\\u003e8\\u003c/span\\u003e]. In Europe, national incidence rates vary significantly among countries and regions by as much as twentyfold while death trends also differ [\\u003cspan citationid=\\\"CR5\\\" class=\\\"CitationRef\\\"\\u003e5\\u003c/span\\u003e]. Conversely, Asia experiences relatively low burden of skin cancer [\\u003cspan citationid=\\\"CR9\\\" class=\\\"CitationRef\\\"\\u003e9\\u003c/span\\u003e\\u0026ndash;\\u003cspan citationid=\\\"CR10\\\" class=\\\"CitationRef\\\"\\u003e10\\u003c/span\\u003e]. An up-to-date understanding could stimulate greater concern for high-risk areas prompting targeted early detection efforts along with increased medical resources allocation for prevention and research purposes. However, comprehensive global perspective studies are scarce with most focusing on specific countries or regions; furthermore, current evidence remains lacking [\\u003cspan citationid=\\\"CR11\\\" class=\\\"CitationRef\\\"\\u003e11\\u003c/span\\u003e]. Notably absent are reports reflecting epidemiological characteristics of MM encompassing all aspects including incidence rates, DALYs (disability-adjusted life years), deaths combined with predictive analysis.\\u003c/p\\u003e \\u003cp\\u003eTo address this gap, we utilized GBD 2021 data from 1990\\u0026ndash;2021 across 204 countries and 21GBD regions extracting relevant data on incidence, DALYs, and deaths related to MM revealing geographical features, temporal trends, distribution patterns by age, gender and sociodemographic Index (SDI) scores. Moreover, we provided a prediction of the global burden of MM for the next 20 years.\\u003c/p\\u003e\"},{\"header\":\"Methods\",\"content\":\"\\u003cp\\u003eGBD uses a standardized statistical framework to analyse cancer registry data and cause-of-death data from countries and different time periods [\\u003cspan citationid=\\\"CR12\\\" class=\\\"CitationRef\\\"\\u003e12\\u003c/span\\u003e]. DALYs represent the total number of years lost due to disease, disability, or premature death in a specific population and are used to measure the disability burden associated with a disease or condition. SDI is a composite indicator that includes per capita income, average education level of individuals aged 15 and above, and total fertility rate of individuals aged 25 and below. By adjusting the SDI index from 0.00 to 1.00 and then multiplying by 100, it can reflect the five different levels of development of countries and regions: low (\\u0026lt;\\u0026thinsp;0.46), low-medium (0.46\\u0026ndash;0.60), medium (0.61\\u0026ndash;0.69), high (0.70\\u0026ndash;0.81), and very High (\\u0026gt;\\u0026thinsp;0.81) [\\u003cspan citationid=\\\"CR13\\\" class=\\\"CitationRef\\\"\\u003e13\\u003c/span\\u003e].\\u003c/p\\u003e \\u003cp\\u003eIn the International Classification of Diseases, 9th revision (ICD-9), the code for MM is 172.x, where \\\"x\\\" represents the type and location of melanoma. According to the ICD-10, the code for MM is C43.x; similarly, \\\"x\\\" represents the specific type and location of melanoma. According to the ICD-11, the code for MM is 2B51, and melanoma is included in the chapter on skin tumours.\\u003c/p\\u003e \\u003cp\\u003eAll data sources used in this study can be accessed through the GBD Global Health Data Exchange Index (\\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003ehttp://ghdx.healthdata.org/gbd-2021/data-input-sources\\u003c/span\\u003e\\u003cspan address=\\\"http://ghdx.healthdata.org/gbd-2021/data-input-sources\\\" targettype=\\\"URL\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e). The search criteria, including sex, age group, time range (1990\\u0026ndash;2021), and location (21 GBD regions, five SDI region groups, and 204 countries), were set according to the needs of each part of the study to query incidence rates, numbers of DALYs, death rates, age-standardized incidence rate (ASIRs), age-standardized DALY rate(ASDRs), and age-standardized mortality rate༈ASMRs༉ to estimate the burden level and temporal trends of MM.\\u003c/p\\u003e \\u003cp\\u003eThis study adhered to the Guidelines for Accurate and Transparent Health Estimates Reporting (GATHER). This study used publicly available data from the GHDx query tool without identifiable information and was considered exempt from review by the University of Toledo Institutional Review Board.\\u003c/p\\u003e \\u003cdiv id=\\\"Sec3\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eStatistical analyses\\u003c/h2\\u003e \\u003cp\\u003eWe used the estimated annual percentage change (EAPC) to quantify the dynamic trend of the global MM burden from 1990 to 2021. In short, we used a regression line model to describe these data. The annual average ASR (age standardized rate) growth rate was fitted using a natural logarithmic model, i.e., y\\u0026thinsp;=\\u0026thinsp;α\\u0026thinsp;+\\u0026thinsp;βx + ɛ, where y\\u0026thinsp;=\\u0026thinsp;ln (ASR) and x is the calendar year. The estimated EAPC of the ASR was 100\\u0026times;(exp(β)-1), and the 95% confidence interval (CI) was calculated. To predict the incidence and mortality rates for the next 20 years, a Bayesian age-period-cohort (BAPC) model was used with default parameters, for studying the multiplier effects of age, period, and cohort: η\\u003csub\\u003eij\\u003c/sub\\u003e = \\u0026micro;\\u0026thinsp;+\\u0026thinsp;α\\u003csub\\u003ei\\u003c/sub\\u003e\\u0026thinsp;+\\u0026thinsp;β\\u003csub\\u003ej\\u003c/sub\\u003e\\u0026thinsp;+\\u0026thinsp;γ\\u003csub\\u003ek\\u003c/sub\\u003e. In this model, η\\u003csub\\u003eij\\u003c/sub\\u003e represents the ASR, \\u0026micro; represents the intercept, α\\u003csub\\u003ei\\u003c/sub\\u003e and γ\\u003csub\\u003ek\\u003c/sub\\u003e represent the age and cohort effects, respectively [\\u003cspan citationid=\\\"CR14\\\" class=\\\"CitationRef\\\"\\u003e14\\u003c/span\\u003e]. All the statistical data analyses and graphing were performed using the R programming language (V4. 4. 0) and JD-GBDR (V2.14, China). A two-sided \\u003cem\\u003ep\\u003c/em\\u003e value\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.05 was considered to indicate statistical significance.\\u003c/p\\u003e \\u003c/div\\u003e\"},{\"header\":\"Results\",\"content\":\"\\u003cp\\u003e\\u003cstrong\\u003e1. Main findings\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eTable 1 shows that the number of MM cases worldwide in 2021 was 303,104.6 (95% UI: 318,904.8-281,717.6), with an ASIR was 3.6 (95% CI: 3.7-3.3) per 100,000 people. In 1990, the estimated global incidence of melanoma for all age groups was 1,243,199.8 (95% UI: 1,276,610.5-1,196,033.9), with an ASIR of 3 (95% CI: 3.1-3) per 100,000 people. The EAPC of the ASIR from 1990 to 2021 was 0.6% (95% CI: 0.3-1.0%).\\u003c/p\\u003e\\n\\u003cp\\u003eTable 1: Incidence, ASIRs, and EAPCs of malignant melanoma globally and in 5 regions with different SDI scores and 21 GBD regions in 1990 and 2021\\u003c/p\\u003e\\n\\u003ctable border=\\\"0\\\" cellspacing=\\\"0\\\" cellpadding=\\\"0\\\" width=\\\"83%\\\"\\u003e\\n \\u003ctbody\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 15px;\\\"\\u003e\\u0026nbsp;\\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 20px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e1990\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 15px;\\\"\\u003e\\u0026nbsp;\\u003cp\\u003e\\u003cstrong\\u003e\\u0026nbsp;\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 18px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e2021\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 15px;\\\"\\u003e\\u0026nbsp;\\u003cp\\u003e\\u003cstrong\\u003e\\u0026nbsp;\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 14px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e1990-2021\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 15px;\\\"\\u003e\\u0026nbsp;\\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 20px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eIncidence (No. cases) (95% UI)\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 15px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eASIR per 100,000 people (95% CI)\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 18px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eIncidence (No. cases) (95% UI)\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 15px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eASIR per 100,000 people (95% CI)\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 14px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eEAPC of the ASIR (95% CI)\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 15px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eGlobal\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 20px;\\\"\\u003e\\u0026nbsp;\\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 15px;\\\"\\u003e\\u0026nbsp;\\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 18px;\\\"\\u003e\\u0026nbsp;\\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 15px;\\\"\\u003e\\u0026nbsp;\\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 14px;\\\"\\u003e\\u0026nbsp;\\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 15px;\\\"\\u003e\\n \\u003cp\\u003eBoth sexes\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 20px;\\\"\\u003e\\n \\u003cp\\u003e124,319.8 (127,610.5-119,603.9)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 15px;\\\"\\u003e\\n \\u003cp\\u003e3 (3.1-2.9)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 18px;\\\"\\u003e\\n \\u003cp\\u003e303,104.6 (318,904.8-281,717.6)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 15px;\\\"\\u003e\\n \\u003cp\\u003e3.6 (3.7-3.3)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 14px;\\\"\\u003e\\n \\u003cp\\u003e0.6 (0.3-1.0)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 15px;\\\"\\u003e\\n \\u003cp\\u003eMale\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 20px;\\\"\\u003e\\n \\u003cp\\u003e61,693.1 (63,465.5-59,289.8)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 15px;\\\"\\u003e\\n \\u003cp\\u003e3.2 (3.3-3.1)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 18px;\\\"\\u003e\\n \\u003cp\\u003e161,315.9 (171,042.7-150,889.9)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 15px;\\\"\\u003e\\n \\u003cp\\u003e4.1 (4.4-3.8)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 14px;\\\"\\u003e\\n \\u003cp\\u003e0.9 (0.5-1.3)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 15px;\\\"\\u003e\\n \\u003cp\\u003eFemale\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 20px;\\\"\\u003e\\n \\u003cp\\u003e62,626.7 (64,845.3-59,679.9)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 15px;\\\"\\u003e\\n \\u003cp\\u003e2.8 (2.9-2.7)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 18px;\\\"\\u003e\\n \\u003cp\\u003e141,788.8 (153,060-130,334.8)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 15px;\\\"\\u003e\\n \\u003cp\\u003e3.2 (3.4-2.9)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 14px;\\\"\\u003e\\n \\u003cp\\u003e0.4 (0.1-0.7)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 15px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eSDI\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 20px;\\\"\\u003e\\u0026nbsp;\\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 15px;\\\"\\u003e\\u0026nbsp;\\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 18px;\\\"\\u003e\\u0026nbsp;\\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 15px;\\\"\\u003e\\u0026nbsp;\\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 14px;\\\"\\u003e\\u0026nbsp;\\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 15px;\\\"\\u003e\\n \\u003cp\\u003eHigh\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 20px;\\\"\\u003e\\n \\u003cp\\u003e93,901.9 (95,913.8-91,263.6)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 15px;\\\"\\u003e\\n \\u003cp\\u003e9 (9.2-8.7)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 18px;\\\"\\u003e\\n \\u003cp\\u003e204,511.2 (212,086.9-191,891)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 15px;\\\"\\u003e\\n \\u003cp\\u003e11.4 (11.7-10.8)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 14px;\\\"\\u003e\\n \\u003cp\\u003e0.7 (0.3-1.1)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 15px;\\\"\\u003e\\n \\u003cp\\u003eHigh-middle\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 20px;\\\"\\u003e\\n \\u003cp\\u003e21,284.6 (22,131.7-20,059.4)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 15px;\\\"\\u003e\\n \\u003cp\\u003e2.1 (2.2-2)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 18px;\\\"\\u003e\\n \\u003cp\\u003e64,796.4 (69,920.9-57,763.5)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 15px;\\\"\\u003e\\n \\u003cp\\u003e3.5 (3.8-3.1)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 14px;\\\"\\u003e\\n \\u003cp\\u003e1.7 (1.5-1.9)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 15px;\\\"\\u003e\\n \\u003cp\\u003eLow\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 20px;\\\"\\u003e\\n \\u003cp\\u003e1,428.3 (1,816.5-913.4)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 15px;\\\"\\u003e\\n \\u003cp\\u003e0.5 (0.7-0.4)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 18px;\\\"\\u003e\\n \\u003cp\\u003e3,942.4 (5,179.4-2,371.7)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 15px;\\\"\\u003e\\n \\u003cp\\u003e0.6 (0.8-0.4)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 14px;\\\"\\u003e\\n \\u003cp\\u003e0.4 (0.3-0.5)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 15px;\\\"\\u003e\\n \\u003cp\\u003eLow-middle\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 20px;\\\"\\u003e\\n \\u003cp\\u003e2,026.5 (2,539.3-1,474.5)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 15px;\\\"\\u003e\\n \\u003cp\\u003e0.3 (0.4-0.2)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 18px;\\\"\\u003e\\n \\u003cp\\u003e7,126 (8,762.7-4,900.2)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 15px;\\\"\\u003e\\n \\u003cp\\u003e0.5 (0.6-0.3)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 14px;\\\"\\u003e\\n \\u003cp\\u003e1.4 (1.3-1.4)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 15px;\\\"\\u003e\\n \\u003cp\\u003eMiddle\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 20px;\\\"\\u003e\\n \\u003cp\\u003e5,558.4 (6,324.9-4,233.7)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 15px;\\\"\\u003e\\n \\u003cp\\u003e0.5 (0.6-0.4)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 18px;\\\"\\u003e\\n \\u003cp\\u003e22,390.9 (26,455.3-16,319.7)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 15px;\\\"\\u003e\\n \\u003cp\\u003e0.8 (1-0.6)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 14px;\\\"\\u003e\\n \\u003cp\\u003e1.8 (1.7-1.8)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 15px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e21 regions\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 20px;\\\"\\u003e\\u0026nbsp;\\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 15px;\\\"\\u003e\\u0026nbsp;\\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 18px;\\\"\\u003e\\u0026nbsp;\\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 15px;\\\"\\u003e\\u0026nbsp;\\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 14px;\\\"\\u003e\\u0026nbsp;\\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 15px;\\\"\\u003e\\n \\u003cp\\u003eAndean Latin America\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 20px;\\\"\\u003e\\n \\u003cp\\u003e197.4 (256-152.3)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 15px;\\\"\\u003e\\n \\u003cp\\u003e0.9 (1.2-0.7)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 18px;\\\"\\u003e\\n \\u003cp\\u003e889.0 (1,143.4-679.2)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 15px;\\\"\\u003e\\n \\u003cp\\u003e1.5 (1.9-1.1)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 14px;\\\"\\u003e\\n \\u003cp\\u003e1.7 (1.5-1.8)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 15px;\\\"\\u003e\\n \\u003cp\\u003eAustralasia\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 20px;\\\"\\u003e\\n \\u003cp\\u003e6,723.4 (7,113.4-6,333.3)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 15px;\\\"\\u003e\\n \\u003cp\\u003e29.5 (312.2-27.8)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 18px;\\\"\\u003e\\n \\u003cp\\u003e15,279.1 (16,829.2-13,732.3)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 15px;\\\"\\u003e\\n \\u003cp\\u003e32.4 (35.175-29.599)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 14px;\\\"\\u003e\\n \\u003cp\\u003e0.5 (-0.0-1.0)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 15px;\\\"\\u003e\\n \\u003cp\\u003eCaribbean\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 20px;\\\"\\u003e\\n \\u003cp\\u003e188.4 (210.4-172.8)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 15px;\\\"\\u003e\\n \\u003cp\\u003e0.7 (0.8-0.6)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 18px;\\\"\\u003e\\n \\u003cp\\u003e593.4 (680.6-518.7)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 15px;\\\"\\u003e\\n \\u003cp\\u003e1.1 (1.3-1)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 14px;\\\"\\u003e\\n \\u003cp\\u003e1.2 (0.9-1.4)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 15px;\\\"\\u003e\\n \\u003cp\\u003eCentral Asia\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 20px;\\\"\\u003e\\n \\u003cp\\u003e541.2 (591.4-496.4)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 15px;\\\"\\u003e\\n \\u003cp\\u003e1.1 (1.2-1.0)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 18px;\\\"\\u003e\\n \\u003cp\\u003e924.7 (1,059.2-821.3)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 15px;\\\"\\u003e\\n \\u003cp\\u003e1.1 (1.2-1)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 14px;\\\"\\u003e\\n \\u003cp\\u003e-0.3 (-0.7-0.1)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 15px;\\\"\\u003e\\n \\u003cp\\u003eCentral Europe\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 20px;\\\"\\u003e\\n \\u003cp\\u003e5,051.1 (5,504.2-4,797.2)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 15px;\\\"\\u003e\\n \\u003cp\\u003e3.5 (3.8-3.3)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 18px;\\\"\\u003e\\n \\u003cp\\u003e14 ,587.7 (16,008.4-13,107.2)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 15px;\\\"\\u003e\\n \\u003cp\\u003e7.7 (8.4-6.9)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 14px;\\\"\\u003e\\n \\u003cp\\u003e2.8 (2.5-3.0)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 15px;\\\"\\u003e\\n \\u003cp\\u003eCentral Latin America\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 20px;\\\"\\u003e\\n \\u003cp\\u003e615.6 (632.5-598.1)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 15px;\\\"\\u003e\\n \\u003cp\\u003e0.7(0.7-0.7)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 18px;\\\"\\u003e\\n \\u003cp\\u003e3,521 (3,901.5-3,139.2)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 15px;\\\"\\u003e\\n \\u003cp\\u003e1.4 (1.5-1.2)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 14px;\\\"\\u003e\\n \\u003cp\\u003e2.1 (1.9-2.3)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 15px;\\\"\\u003e\\n \\u003cp\\u003eCentral Sub-Saharan Africa\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 20px;\\\"\\u003e\\n \\u003cp\\u003e121.3 (186.1-87)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 15px;\\\"\\u003e\\n \\u003cp\\u003e0.5 (0.8-0.4)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 18px;\\\"\\u003e\\n \\u003cp\\u003e379.5 (605.7-252.8)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 15px;\\\"\\u003e\\n \\u003cp\\u003e0.6 (0.9-0.4)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 14px;\\\"\\u003e\\n \\u003cp\\u003e0.7 (0.5-0.9)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 15px;\\\"\\u003e\\n \\u003cp\\u003eEast Asia\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 20px;\\\"\\u003e\\n \\u003cp\\u003e3,396.5 (4,276.1-2,231.4)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 15px;\\\"\\u003e\\n \\u003cp\\u003e0.4 (0.5-0.2)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 18px;\\\"\\u003e\\n \\u003cp\\u003e13,830.8 (18,381.1-7,571.1)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 15px;\\\"\\u003e\\n \\u003cp\\u003e0.7 (0.9-0.4)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 14px;\\\"\\u003e\\n \\u003cp\\u003e2.2 (2.0-2.4)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 15px;\\\"\\u003e\\n \\u003cp\\u003eEastern Europe\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 20px;\\\"\\u003e\\n \\u003cp\\u003e6,987.6 (7,414.7-6,679.5)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 15px;\\\"\\u003e\\n \\u003cp\\u003e2.6 (2.8-2.5)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 18px;\\\"\\u003e\\n \\u003cp\\u003e19,495 (21,098.5-17,958.4)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 15px;\\\"\\u003e\\n \\u003cp\\u003e6.3 (6.8-5.8)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 14px;\\\"\\u003e\\n \\u003cp\\u003e2.9 (2.7-3.1)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 15px;\\\"\\u003e\\n \\u003cp\\u003eEastern Sub-Saharan Africa\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 20px;\\\"\\u003e\\n \\u003cp\\u003e886.2 (1,107.8-582.6)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 15px;\\\"\\u003e\\n \\u003cp\\u003e1 (1.2-0.7)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 18px;\\\"\\u003e\\n \\u003cp\\u003e2,524.4 (3,627.6-1,453.8)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 15px;\\\"\\u003e\\n \\u003cp\\u003e1.1 (1.6-0.7)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 14px;\\\"\\u003e\\n \\u003cp\\u003e0.3 (0.2-0.4)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 15px;\\\"\\u003e\\n \\u003cp\\u003eHigh-income Asia Pacific\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 20px;\\\"\\u003e\\n \\u003cp\\u003e1,752.5 (1,865-1,630.7)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 15px;\\\"\\u003e\\n \\u003cp\\u003e0.9(0.9-0.8)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 18px;\\\"\\u003e\\n \\u003cp\\u003e6,107.9 (6,843.5-5,146.5)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 15px;\\\"\\u003e\\n \\u003cp\\u003e1.8 (2-1.5)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 14px;\\\"\\u003e\\n \\u003cp\\u003e2.4 (2.0-2.8)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 15px;\\\"\\u003e\\n \\u003cp\\u003eHigh-income North America\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 20px;\\\"\\u003e\\n \\u003cp\\u003e56,185.3 (57,369.9-54,303.8)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 15px;\\\"\\u003e\\n \\u003cp\\u003e17.1 (17.5-16.6)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 18px;\\\"\\u003e\\n \\u003cp\\u003e97,139.1 (100,890.6-91,218.2)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 15px;\\\"\\u003e\\n \\u003cp\\u003e16.6 (17.2-15.7)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 14px;\\\"\\u003e\\n \\u003cp\\u003e-0.2 (-0.6-0.3)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 15px;\\\"\\u003e\\n \\u003cp\\u003eNorth Africa and Middle East\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 20px;\\\"\\u003e\\n \\u003cp\\u003e1,745.8 (2,482.5-899.3)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 15px;\\\"\\u003e\\n \\u003cp\\u003e0.9 (1.3-0.5)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 18px;\\\"\\u003e\\n \\u003cp\\u003e10,414.4 (12,844.1-5,662.2)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 15px;\\\"\\u003e\\n \\u003cp\\u003e2.2(2.7-1.2)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 14px;\\\"\\u003e\\n \\u003cp\\u003e2.9 (2.8-2.9)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 15px;\\\"\\u003e\\n \\u003cp\\u003eOceania\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 20px;\\\"\\u003e\\n \\u003cp\\u003e9.2 (16.4-6.3)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 15px;\\\"\\u003e\\n \\u003cp\\u003e0.3 (0.6-0.2)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 18px;\\\"\\u003e\\n \\u003cp\\u003e23.9 (38.4-16.4)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 15px;\\\"\\u003e\\n \\u003cp\\u003e0.3 (0.5-0.2)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 14px;\\\"\\u003e\\n \\u003cp\\u003e-0.0 (-0.0-0.0)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 15px;\\\"\\u003e\\n \\u003cp\\u003eSouth Asia\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 20px;\\\"\\u003e\\n \\u003cp\\u003e1,470.2 (1,955.6-1,032.5)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 15px;\\\"\\u003e\\n \\u003cp\\u003e0.2 (0.3-0.2)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 18px;\\\"\\u003e\\n \\u003cp\\u003e5 ,390.8 (7,543.0-3,472.4)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 15px;\\\"\\u003e\\n \\u003cp\\u003e0.3 (0.5-0.2)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 14px;\\\"\\u003e\\n \\u003cp\\u003e1.2 (1.1-1.4)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 15px;\\\"\\u003e\\n \\u003cp\\u003eSoutheast Asia\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 20px;\\\"\\u003e\\n \\u003cp\\u003e515.1(731.2-400.5)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 15px;\\\"\\u003e\\n \\u003cp\\u003e0.2 (0.3-0.1)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 18px;\\\"\\u003e\\n \\u003cp\\u003e1,581.9 (2,124-1,089.3)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 15px;\\\"\\u003e\\n \\u003cp\\u003e0.2 (0.3-0.2)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 14px;\\\"\\u003e\\n \\u003cp\\u003e0.8 (0.7-0.8)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 15px;\\\"\\u003e\\n \\u003cp\\u003eSouthern Latin America\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 20px;\\\"\\u003e\\n \\u003cp\\u003e684.3 (718.2-651.2)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 15px;\\\"\\u003e\\n \\u003cp\\u003e1.5 (1.5-1.4)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 18px;\\\"\\u003e\\n \\u003cp\\u003e2,472.7 (2,647.8-2,317.6)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 15px;\\\"\\u003e\\n \\u003cp\\u003e3 (3.2-2.8)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 14px;\\\"\\u003e\\n \\u003cp\\u003e2.1 (1.7-2.6)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 15px;\\\"\\u003e\\n \\u003cp\\u003eSouthern Sub-Saharan Africa\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 20px;\\\"\\u003e\\n \\u003cp\\u003e410.4 (552.1-301.5)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 15px;\\\"\\u003e\\n \\u003cp\\u003e1.4 (1.8-1)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 18px;\\\"\\u003e\\n \\u003cp\\u003e1,221.3 (1,555.7-722.3)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 15px;\\\"\\u003e\\n \\u003cp\\u003e2 (2.4-1.1)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 14px;\\\"\\u003e\\n \\u003cp\\u003e1.3 (1.2-1.4)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 15px;\\\"\\u003e\\n \\u003cp\\u003eTropical Latin America\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 20px;\\\"\\u003e\\n \\u003cp\\u003e1,305.4 (1,353.6-1,260.9)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 15px;\\\"\\u003e\\n \\u003cp\\u003e1.3 (1.3-1.2)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 18px;\\\"\\u003e\\n \\u003cp\\u003e4,947.6 (5 ,185-4 68.9)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 15px;\\\"\\u003e\\n \\u003cp\\u003e1.9 (2-1.8)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 14px;\\\"\\u003e\\n \\u003cp\\u003e1.2 (1.1-1.4)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 15px;\\\"\\u003e\\n \\u003cp\\u003eWestern Europe\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 20px;\\\"\\u003e\\n \\u003cp\\u003e35,074.4 (36,115.4-33,846.3)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 15px;\\\"\\u003e\\n \\u003cp\\u003e7 (7.2-6.8)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 18px;\\\"\\u003e\\n \\u003cp\\u003e100,441.7 (105,087.2-94,012.4)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 15px;\\\"\\u003e\\n \\u003cp\\u003e13.7 (14.2-13.1)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 14px;\\\"\\u003e\\n \\u003cp\\u003e2.5 (2.0-2.9)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 15px;\\\"\\u003e\\n \\u003cp\\u003eWestern Sub-Saharan Africa\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 20px;\\\"\\u003e\\n \\u003cp\\u003e458.5 (625.3-228.3)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 15px;\\\"\\u003e\\n \\u003cp\\u003e0.5 (0.6-0.2)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 18px;\\\"\\u003e\\n \\u003cp\\u003e1,338.8 (1,903.6-516.8)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 15px;\\\"\\u003e\\n \\u003cp\\u003e0.6 (0.8-0.2)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 14px;\\\"\\u003e\\n \\u003cp\\u003e0.5 (0.4-0.6)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/tbody\\u003e\\n\\u003c/table\\u003e\\n\\u003cp\\u003eAbbreviations: SDI, sociodemographic index; ASIR, age-standardized incidence rate; UI, uncertainty interval; CI, confidence interval; EAPC, estimated annual percentage change\\u003c/p\\u003e\\n\\u003cp\\u003eTable 2 shows that the number of DALYs for individuals with MM worldwide in 2021 was 1,678,836 (95% UI: 1,837,369-1,474,534), with an ASDR of 19.6 (95% CI: 21.5-17.2) per 100,000 people. In 1990, the estimated global number of DALYs for MM patients of all ages was 10,457,77.5 (95% UI: 11,038,449-9,593,733.2), with an ASDR of 24.3 (95% CI: 25.6-22.4) per 100,000 people. The EAPC of the ASDR from 1990 to 2021 was -0.7% (95% CI: -0.8-0.5%).\\u003c/p\\u003e\\n\\u003cp\\u003eTable 2: DALYs, ASDRs, and EAPCs for malignant melanoma globally and in 5 regions with different SDI scores and 21 GBD regions in 1990 and 2021\\u003c/p\\u003e\\n\\u003ctable border=\\\"0\\\" cellspacing=\\\"0\\\" cellpadding=\\\"0\\\"\\u003e\\n \\u003ctbody\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e\\u0026nbsp;\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e1990\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e\\u0026nbsp;\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e2021\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e\\u0026nbsp;\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e1990-2021\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e\\u0026nbsp;\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eNo. of DALYs (95% UI)\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eASDR per 100 000 people (95% CI)\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eNo. of DALYs (95% UI)\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eASDR per 100 000 people (95% CI)\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eEAPC of the ASDR (95% CI)\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eGlobal\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eBoth sexes\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e1,045,777.5 (1,103,849-959,373.2)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e24.3 (25.6-22.4)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e1,678,836 (1,837,369-1,474,534)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e19.6 (21.5-17.2)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e-0.7 (-0.8--0.5)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eMale\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e576,637.9 (617,161.4-517,184.3)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e28.1(30-25.3)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e942,404.4 (1,056,864-822,097.6)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e23.2 (26-20.3)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e-0.5 (-0.7\\u0026mdash;0.4)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eFemale\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e469,139.6 (517,864.3-420,903.4)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e21.0 (23.2-18.9)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e736,431.9 (851,312.3-615,594.7)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e16.6 (19.2-13.8)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e-0.8 (-0.9--0.7)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eSDI\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eHigh\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e553,624.1 (572,213.2-536,872.7)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e53.4 (55.2-51.9)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e725,831.6 (769,618.4-682,352.4)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e41 (43.4-38.9)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e-0.7 (-0.8--0.5)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eHigh-middle\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e264,662.8 (278,416.1-242,600.8)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e25.5 (26.8-23.4)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e428,049.8 (463,677-378,977.6)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e23.3 (25.2-20.6)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e-0.3 (-0.5--0.2)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eLow\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e42,672.6 (54,250.8-27,239.4)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e14.8 (18.7-9.5)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e100,368.2 (134,250.3-59,920.9)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e14.6 (19.3-8.8)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e-0.2 (-0.2--0.1)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eLow-middle\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e54,546.5 (68,759.3-39,683.5)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e7.3 (9.2-5.4)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e140,995.4 (179,625.6-96,861)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e8.5 (10.9-5.9)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e0.5 (0.5-0.5)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eMiddle\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e128,660.5(148,647-97,135.4)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e10.4 (12.1-8)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e281,236.8(329,491.2-209,527.5)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e10.3 (12-7.7)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e-0.1 (-0.2--0.1)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e21 regions\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eAndean Latin America\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e4,666.9 (6,171.7-3,556.4)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e20.3 (26.7-15.4)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e12,219.3 (15,679.1-9,210.9\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e20 (25.5-15.1)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e0.0 (-0.1-0.1)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eAustralasia\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e44,593.7 (47,089.8-42,040.6)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e196 (207.0-184.8)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e51,338.5 (56,880-46,475.2)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e110 (120.6-100.6)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e-1.8 (-2.2--1.4)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eCaribbean\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e3,394 (2,973.7-4,097.4)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e12.1 (14.5-10.7)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e7,359.7 (9,020.1-6,180.3)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e13.9 (17.1-11.6)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e0.2 (-0.0--0.4)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eCentral Asia\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e9,956.2 (10,884.7-9,134.8)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e19.6 (21.4-17.9)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e12,833.1 (14,829.2-11,102.4)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e14.8 (17.0-12.9)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e-1.3 (-1.6--1.0)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eCentral Europe\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e75,339.7 (81,349.7-71,227.9)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e52.5 (56.7-49.6)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e108,838 (118,197.9-98,914.4)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e58.3 (63.5-52.8)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e-1.3 (-1.6--1.0)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eCentral Latin America\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e13,483.7 (13,827.4-13,145.1)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e13.5 (13908-13.2)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e46,904 (51,763.9-42,082.3)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e18.2 (20.1-16.3)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e0.7 (0.6-0.8)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eCentral Sub-Saharan Africa\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e3,599 (5,508.1-2,564.8)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e13 (20-9.3)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e9,933.1 (16,194.1-6,666.3)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e13.9 (22-9.1)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e0.3 (0.2-0.4)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eEast Asia\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e92,402.9 (114,970.2-58,181.5)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e9 (11.3-5.9)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e160,829.5 (212,715.7-89,349)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e7.9 (10.4-4.4)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e-0.5 (-0.6--0.3)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eEastern Europe\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e99,534.4 (105,417.7-95,372.9)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e37.7 (40-36.1)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e164,701.2 (180,397-150,656.8)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e54 (59.2-49.2)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e1.0 (0.7-1.3)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eEastern Sub-Saharan Africa\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e27,117.9 (34,250-17,681.8)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e27 (33.9-17.8)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e67,196.8 (96,675.4-38,352)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e27 (38.1-15.6)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e-0.1 (-0.2--0.1)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eHigh-income Asia Pacific\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e13 864.7 (14 935.6-12 586)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e6.9 (7.5-6.3)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e23,622.8 (26,422.9-20,041.7)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e6.9 (7.7-5.8)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e0.0 (-0.2-0.2)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eHigh-income North America\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e254,121.9 (263,281-245,110.8)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e78.8 (81.7-76.1)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e292,143.4 (310,795-274,912.2)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e51.1 (54.1-48.2)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e-1.4 (-1.6--1.1)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eNorth Africa and Middle East\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e17,510.6 (26,204.9-8,479.8)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e9 (13.1-4.5)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e375 59 (45,928.6-19,940.4)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e7.6 (9.3-4)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e-0.6 (-0.7--0.5)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eOceania\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e271.2 (482.6-182.8)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e8 (14.3-5.5)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e691 (1,104.1-469.1)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e7.9 (12.7-5.5)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e0.0 (0.0-0.0)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eSouth Asia\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e42,751.5 (57,680.7-30,022.9)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e5.8 (7.8-4.1)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e108,847.8 (151,823.3-72,708.3)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e6.4 (8.9-4.3)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e0.2 (0.2-0.3)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eSoutheast Asia\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e15,260.1 (21,599.8-11,475.5)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e4.9 (7-3.8)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e37,794.3 (50,051-26,157.6)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e5.4 (7.1-3.7)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e0.2 (0.2-0.3)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eSouthern Latin America\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e12,050.9 (12,629.7-11,410.3)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e25.8 (27-24.4)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e24,482.3 (26,192.2-23,023.2)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e29.9 (32-28.1)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e0.4 (-0.0-0.8)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eSouthern Sub-Saharan Africa\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e9,818.7(13,487.9-7,396.6)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e34.5 (41.4-22.4)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e25,073.0 (32,363.8-15,225.4)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e37.6 (47.4-22.6)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e0.8 (0.7-1.0）\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eTropical Latin America\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e29,819 (30,803.3-28,860.2)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e27 (28-26.1)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e70,160.4 (73,106.6-66,555.4)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e27 (28.1-25.6)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e-0.1 (-0.3-0.0）\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eWestern Europe\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e262,977.7 (270,867-254,028)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e53.4 (54.9-51.8)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e383,503.1 (407,460.3-357,556)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e52.6 (55.6-49.7)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e0.2 (-0.0-0.4）\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eWestern Sub-Saharan Africa\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e13,243.2 (18,321.2-6,417.3)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e12.3 (16.9-6.1)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e32,805.8 (46,376.8-12,756.6)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e12.2 (16.9-5.1)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e-0.1 (-0.--0.0）\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/tbody\\u003e\\n\\u003c/table\\u003e\\n\\u003cp\\u003eAbbreviations: DALYs, disability-adjusted life years\\u003c/p\\u003e\\n\\u003cp\\u003eTable 3 shows that the number of deaths of MM worldwide in 2021 was 61,549 (95% UI: 66,265-54,852.5), with an ASMR of 0.7 (95% CI: 0.8-0.7) per 100,000 people. In 1990, the estimated global number of deaths due to melanoma for all age groups was 33,061 (95% UI: 34,529.5-30,546.4), with an ASMR of 0.8 (95% CI: 0.9-0.8) per 100,000 people. The EAPC of the ASMR from 1990 to 2021 was -0.4% (95% CI: -0.6%-0.3%).\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003eTable 3: Number of deaths, ASMRs, and EAPCs for malignant melanoma globally and in 5 regions with different SDI scores and 21 GBD regions in 1990 and 2021\\u003c/p\\u003e\\n\\u003ctable border=\\\"0\\\" cellspacing=\\\"0\\\" cellpadding=\\\"0\\\" width=\\\"79%\\\"\\u003e\\n \\u003ctbody\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 16px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e\\u0026nbsp;\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 16px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e1990\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 16px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e\\u0026nbsp;\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 21px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e2021\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 16px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e\\u0026nbsp;\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 11px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e1990-2021\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 16px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e\\u0026nbsp;\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 16px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eNo. of deaths (95% UI)\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 16px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eASMR per 100,000 people (95% CI)\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 21px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eNo. of deaths (95% UI)\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 16px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eASMR per 100,000 people (95% CI)\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 11px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eEAPC of the ASMR (95% CI)\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 16px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eGlobal\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 16px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 16px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 21px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 16px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 11px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 16px;\\\"\\u003e\\n \\u003cp\\u003eBoth sexes\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 16px;\\\"\\u003e\\n \\u003cp\\u003e33,061 (34,529.5-30,546.4)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 16px;\\\"\\u003e\\n \\u003cp\\u003e0.8 (0.9-0.8)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 21px;\\\"\\u003e\\n \\u003cp\\u003e61,549 (66,265-54,852.5)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 16px;\\\"\\u003e\\n \\u003cp\\u003e0.7 (0.8-0.7)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 11px;\\\"\\u003e\\n \\u003cp\\u003e-0.4 (-0.6--0.3)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 16px;\\\"\\u003e\\n \\u003cp\\u003eMale\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 16px;\\\"\\u003e\\n \\u003cp\\u003e17,764.1 (18,875-16,089.9)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 16px;\\\"\\u003e\\n \\u003cp\\u003e1 (1.1-1)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 21px;\\\"\\u003e\\n \\u003cp\\u003e34,322.0 (37,624.8-30,494.4)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 16px;\\\"\\u003e\\n \\u003cp\\u003e0.9 (1-0.8)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 11px;\\\"\\u003e\\n \\u003cp\\u003e-0.2 (-0.4--0.0)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 16px;\\\"\\u003e\\n \\u003cp\\u003eFemale\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 16px;\\\"\\u003e\\n \\u003cp\\u003e15,296.8 (16,776-13,840.2)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 16px;\\\"\\u003e\\n \\u003cp\\u003e0.7 (0.8-0.7)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 21px;\\\"\\u003e\\n \\u003cp\\u003e27,227.7 (30,950.5-23,212.2)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 16px;\\\"\\u003e\\n \\u003cp\\u003e0.6 (0.7-0.5)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 11px;\\\"\\u003e\\n \\u003cp\\u003e-0.7 (-0.8--0.6)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 16px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eSDI\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 16px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 16px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 21px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 16px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 11px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 16px;\\\"\\u003e\\n \\u003cp\\u003eHigh\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 16px;\\\"\\u003e\\n \\u003cp\\u003e18,038.1 (18,488.8-17,378.4)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 16px;\\\"\\u003e\\n \\u003cp\\u003e1.7 (1.7-1.6)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 21px;\\\"\\u003e\\n \\u003cp\\u003e28,891.9 (30,286.7-531.4)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 16px;\\\"\\u003e\\n \\u003cp\\u003e1.4 (1.5-1.3)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 11px;\\\"\\u003e\\n \\u003cp\\u003e-0.5 (-0.7--0.3)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 16px;\\\"\\u003e\\n \\u003cp\\u003eHigh-middle\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 16px;\\\"\\u003e\\n \\u003cp\\u003e8,363.7 (8,747.2-7,705)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 16px;\\\"\\u003e\\n \\u003cp\\u003e0.9 (0.9-0.8)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 21px;\\\"\\u003e\\n \\u003cp\\u003e15,762.6 (17,010.7-14,112.1)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 16px;\\\"\\u003e\\n \\u003cp\\u003e0.8 (0.9-0.7)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 11px;\\\"\\u003e\\n \\u003cp\\u003e-0.1 (-0.3-0.0)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 16px;\\\"\\u003e\\n \\u003cp\\u003eLow\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 16px;\\\"\\u003e\\n \\u003cp\\u003e1,198.8 (1,517.8-773.1)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 16px;\\\"\\u003e\\n \\u003cp\\u003e0.5 (0.6-0.3)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 21px;\\\"\\u003e\\n \\u003cp\\u003e2,743.8 (3,616.7-1,656.2)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 16px;\\\"\\u003e\\n \\u003cp\\u003e0.5 (0.6-0.3)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 11px;\\\"\\u003e\\n \\u003cp\\u003e-0.2 (-0.2--0.1)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 16px;\\\"\\u003e\\n \\u003cp\\u003eLow-middle\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 16px;\\\"\\u003e\\n \\u003cp\\u003e1,588.9 (2,011.4-1,173.5)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 16px;\\\"\\u003e\\n \\u003cp\\u003e0.3 (0.3-0.2)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 21px;\\\"\\u003e\\n \\u003cp\\u003e4,284.8 (5,404.7-3,018)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 16px;\\\"\\u003e\\n \\u003cp\\u003e0.3 (0.4-0.2)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 11px;\\\"\\u003e\\n \\u003cp\\u003e0.5 (0.5-0.5)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 16px;\\\"\\u003e\\n \\u003cp\\u003eMiddle\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 16px;\\\"\\u003e\\n \\u003cp\\u003e3,818.9 (4,445.9-2 ,940.1)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 16px;\\\"\\u003e\\n \\u003cp\\u003e0.4 (0.4-0.3)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 21px;\\\"\\u003e\\n \\u003cp\\u003e9,773.3 (11,254.1-7,341.2)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 16px;\\\"\\u003e\\n \\u003cp\\u003e0.4 (0.4-0.3)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 11px;\\\"\\u003e\\n \\u003cp\\u003e-0.0 (-0.1-0.0)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 16px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e21 regions\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 16px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 16px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 21px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 16px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 11px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 16px;\\\"\\u003e\\n \\u003cp\\u003eAndean Latin America\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 16px;\\\"\\u003e\\n \\u003cp\\u003e164.2 (213-126.1)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 16px;\\\"\\u003e\\n \\u003cp\\u003e0.8 (1-0.6)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 21px;\\\"\\u003e\\n \\u003cp\\u003e481 (604.1-361.8)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 16px;\\\"\\u003e\\n \\u003cp\\u003e0.8 (1-0.6)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 11px;\\\"\\u003e\\n \\u003cp\\u003e0.2 (0.0-0.3)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 16px;\\\"\\u003e\\n \\u003cp\\u003eAustralasia\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 16px;\\\"\\u003e\\n \\u003cp\\u003e1,507.3 (1,611.4-1,409.8)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 16px;\\\"\\u003e\\n \\u003cp\\u003e6.5 (7-6.1)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 21px;\\\"\\u003e\\n \\u003cp\\u003e2,072.8 (288.4-1,842.1)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 16px;\\\"\\u003e\\n \\u003cp\\u003e3.9 (4.3-3.5)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 11px;\\\"\\u003e\\n \\u003cp\\u003e-1.6 (-2.0--1.2)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 16px;\\\"\\u003e\\n \\u003cp\\u003eCaribbean\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 16px;\\\"\\u003e\\n \\u003cp\\u003e113.3 (132.8-100.9)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 16px;\\\"\\u003e\\n \\u003cp\\u003e0.4 (0.5-0.4)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 21px;\\\"\\u003e\\n \\u003cp\\u003e270.6 (318.2-233.2)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 16px;\\\"\\u003e\\n \\u003cp\\u003e0.5 (0.6-0.4)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 11px;\\\"\\u003e\\n \\u003cp\\u003e0.2 (-0.0-0.4)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 16px;\\\"\\u003e\\n \\u003cp\\u003eCentral Asia\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 16px;\\\"\\u003e\\n \\u003cp\\u003e339.3 (372.2-308)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 16px;\\\"\\u003e\\n \\u003cp\\u003e0.7 (0.8-0.7)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 21px;\\\"\\u003e\\n \\u003cp\\u003e453.4 (516.3-397.3)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 16px;\\\"\\u003e\\n \\u003cp\\u003e0.6 (0.7-0.5)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 11px;\\\"\\u003e\\n \\u003cp\\u003e-1.0 (-1.3--0.7)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 16px;\\\"\\u003e\\n \\u003cp\\u003eCentral Europe\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 16px;\\\"\\u003e\\n \\u003cp\\u003e2,448.2 (2,650.5-2,309.6)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 16px;\\\"\\u003e\\n \\u003cp\\u003e1.7 (1.9-1.6)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 21px;\\\"\\u003e\\n \\u003cp\\u003e4,454.1 (4,814.8-4,065.9)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 16px;\\\"\\u003e\\n \\u003cp\\u003e2.1 (2.3-1.9)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 11px;\\\"\\u003e\\n \\u003cp\\u003e0.8 (0.6-0.9)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 16px;\\\"\\u003e\\n \\u003cp\\u003eCentral Latin America\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 16px;\\\"\\u003e\\n \\u003cp\\u003e431.9 (443.8-418.7)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 16px;\\\"\\u003e\\n \\u003cp\\u003e0.5 (0.5-0.5)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 21px;\\\"\\u003e\\n \\u003cp\\u003e1,715.9 (1,890.8-1,534.1)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 16px;\\\"\\u003e\\n \\u003cp\\u003e0.7(0.8-0.6)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 11px;\\\"\\u003e\\n \\u003cp\\u003e0.7 (0.6-0.8)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 16px;\\\"\\u003e\\n \\u003cp\\u003eCentral Sub-Saharan Africa\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 16px;\\\"\\u003e\\n \\u003cp\\u003e105.8 (162.2-76.3)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 16px;\\\"\\u003e\\n \\u003cp\\u003e0.5 (0.7-0.3)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 21px;\\\"\\u003e\\n \\u003cp\\u003e289 (460.2-190.9)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 16px;\\\"\\u003e\\n \\u003cp\\u003e0.5 (0.8-0.3)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 11px;\\\"\\u003e\\n \\u003cp\\u003e0.4 (0.3-0.5)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 16px;\\\"\\u003e\\n \\u003cp\\u003eEast Asia\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 16px;\\\"\\u003e\\n \\u003cp\\u003e2,680.8 (3,420.3-1,785)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 16px;\\\"\\u003e\\n \\u003cp\\u003e0.3 (0.4-0.2)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 21px;\\\"\\u003e\\n \\u003cp\\u003e5,646.9 (7,410.3-3,090.4)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 16px;\\\"\\u003e\\n \\u003cp\\u003e0.3 (0.4-0.2)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 11px;\\\"\\u003e\\n \\u003cp\\u003e-0.4 (-0.5--0.4)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 16px;\\\"\\u003e\\n \\u003cp\\u003eEastern Europe\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 16px;\\\"\\u003e\\n \\u003cp\\u003e3,037.9 (3,213.2-2,910)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 16px;\\\"\\u003e\\n \\u003cp\\u003e1.1 (1.2-1.1)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 21px;\\\"\\u003e\\n \\u003cp\\u003e5,744.4 (6,249.7-5,269.1)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 16px;\\\"\\u003e\\n \\u003cp\\u003e1.7 (1.9-1.6)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 11px;\\\"\\u003e\\n \\u003cp\\u003e1.2 (1.0-1.4)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 16px;\\\"\\u003e\\n \\u003cp\\u003eEastern Sub-Saharan Africa\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 16px;\\\"\\u003e\\n \\u003cp\\u003e741.3 (929.5-488.8)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 16px;\\\"\\u003e\\n \\u003cp\\u003e0.9 (1.1-0.6)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 21px;\\\"\\u003e\\n \\u003cp\\u003e1,762.2 (2,472.3-1,017.3)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 16px;\\\"\\u003e\\n \\u003cp\\u003e0.9 (1.2-0.5)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 11px;\\\"\\u003e\\n \\u003cp\\u003e-0.1 (-0.2--0.1)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 16px;\\\"\\u003e\\n \\u003cp\\u003eHigh-income Asia Pacific\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 16px;\\\"\\u003e\\n \\u003cp\\u003e459.1 (490.9-422)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 16px;\\\"\\u003e\\n \\u003cp\\u003e0.2 (0.3-0.2)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 21px;\\\"\\u003e\\n \\u003cp\\u003e1,048.5 (1,178.4-870.1)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 16px;\\\"\\u003e\\n \\u003cp\\u003e0.2 (0.3-0.2)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 11px;\\\"\\u003e\\n \\u003cp\\u003e-0.1 (-0.2-0.1)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 16px;\\\"\\u003e\\n \\u003cp\\u003eHigh-income North America\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 16px;\\\"\\u003e\\n \\u003cp\\u003e7,836.9 (8,017.9-7,497.7)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 16px;\\\"\\u003e\\n \\u003cp\\u003e2.3 (2.4-2.2)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 21px;\\\"\\u003e\\n \\u003cp\\u003e11,152.1 (11,647.8-10,293.6)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 16px;\\\"\\u003e\\n \\u003cp\\u003e1.7 (1.8-1.6)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 11px;\\\"\\u003e\\n \\u003cp\\u003e-0.9 (-1.1--0.6)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 16px;\\\"\\u003e\\n \\u003cp\\u003eNorth Africa and Middle East\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 16px;\\\"\\u003e\\n \\u003cp\\u003e556.6 (804.6-279.8)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 16px;\\\"\\u003e\\n \\u003cp\\u003e0.4 (0.5-0.2)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 21px;\\\"\\u003e\\n \\u003cp\\u003e1,237.8 (1,510.8-635.9)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 16px;\\\"\\u003e\\n \\u003cp\\u003e0.3 (0.4-0.2)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 11px;\\\"\\u003e\\n \\u003cp\\u003e-0.5 (-0.6--0.4)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 16px;\\\"\\u003e\\n \\u003cp\\u003eOceania\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 16px;\\\"\\u003e\\n \\u003cp\\u003e8.6 (15.4-5.8)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 16px;\\\"\\u003e\\n \\u003cp\\u003e0.3 (0.6-0.2)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 21px;\\\"\\u003e\\n \\u003cp\\u003e22.3 (35.8-15.4)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 16px;\\\"\\u003e\\n \\u003cp\\u003e0.3 (0.5-0.2)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 11px;\\\"\\u003e\\n \\u003cp\\u003e-0.1 (-0.1--0.0)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 16px;\\\"\\u003e\\n \\u003cp\\u003eSouth Asia\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 16px;\\\"\\u003e\\n \\u003cp\\u003e1,186.6 (1,589.3-844.9)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 16px;\\\"\\u003e\\n \\u003cp\\u003e0.2 (0.3-0.1)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 21px;\\\"\\u003e\\n \\u003cp\\u003e3,241.9 (4,484.2-2,513.1)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 16px;\\\"\\u003e\\n \\u003cp\\u003e0.2 (0.3-0.14)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 11px;\\\"\\u003e\\n \\u003cp\\u003e0.3 (0.2-0.4)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 16px;\\\"\\u003e\\n \\u003cp\\u003eSoutheast Asia\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 16px;\\\"\\u003e\\n \\u003cp\\u003e453.2 (6545.2-351.1)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 16px;\\\"\\u003e\\n \\u003cp\\u003e0.2 (0.2-0.1)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 21px;\\\"\\u003e\\n \\u003cp\\u003e1,255.7 (1,657.8-863.7)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 16px;\\\"\\u003e\\n \\u003cp\\u003e0.2 (0.3-0.1)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 11px;\\\"\\u003e\\n \\u003cp\\u003e0.4 (0.3-0.4)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 16px;\\\"\\u003e\\n \\u003cp\\u003eSouthern Latin America\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 16px;\\\"\\u003e\\n \\u003cp\\u003e404.4 (422.1-383.2)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 16px;\\\"\\u003e\\n \\u003cp\\u003e0.9 (0.9-0.8)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 21px;\\\"\\u003e\\n \\u003cp\\u003e917.1 (980.9-852.9)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 16px;\\\"\\u003e\\n \\u003cp\\u003e1.1 (1.1-1)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 11px;\\\"\\u003e\\n \\u003cp\\u003e0.5 (1.0-0.9)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 16px;\\\"\\u003e\\n \\u003cp\\u003eSouthern Sub-Saharan Africa\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 16px;\\\"\\u003e\\n \\u003cp\\u003e305.6 (408.7-218.9)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 16px;\\\"\\u003e\\n \\u003cp\\u003e1.1 (1.5-0.8)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 21px;\\\"\\u003e\\n \\u003cp\\u003e794.3 (986-470)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 16px;\\\"\\u003e\\n \\u003cp\\u003e1.4 (1.7-0.8)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 11px;\\\"\\u003e\\n \\u003cp\\u003e0.8 (0.7-1.0)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 16px;\\\"\\u003e\\n \\u003cp\\u003eTropical Latin America\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 16px;\\\"\\u003e\\n \\u003cp\\u003e878.8 (911.7-847.6)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 16px;\\\"\\u003e\\n \\u003cp\\u003e0.9 (1-0.9)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 21px;\\\"\\u003e\\n \\u003cp\\u003e2,499.2 (2,629.5-2,317.9)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 16px;\\\"\\u003e\\n \\u003cp\\u003e1 (1-0.9)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 11px;\\\"\\u003e\\n \\u003cp\\u003e0.2 (0.0-0.3)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 16px;\\\"\\u003e\\n \\u003cp\\u003eWestern Europe\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 16px;\\\"\\u003e\\n \\u003cp\\u003e9,011.1 (9,261.7-8,649.8)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 16px;\\\"\\u003e\\n \\u003cp\\u003e1.7 (1.7-1.6)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 21px;\\\"\\u003e\\n \\u003cp\\u003e15,566 (16,443.2-14,023.1)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 16px;\\\"\\u003e\\n \\u003cp\\u003e1.7 (1.8-1.6)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 11px;\\\"\\u003e\\n \\u003cp\\u003e0.3 (0.2-0.5)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 16px;\\\"\\u003e\\n \\u003cp\\u003eWestern Sub-Saharan Africa\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 16px;\\\"\\u003e\\n \\u003cp\\u003e390 (532.8-198.6)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 16px;\\\"\\u003e\\n \\u003cp\\u003e0.4 (0.6-0.2)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 21px;\\\"\\u003e\\n \\u003cp\\u003e924.5 (1,273.9-387.2)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 16px;\\\"\\u003e\\n \\u003cp\\u003e0.4 (0.6-0.2)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 11px;\\\"\\u003e\\n \\u003cp\\u003e0.0 (-0.0-0.1)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/tbody\\u003e\\n\\u003c/table\\u003e\\n\\u003cp\\u003eAbbreviations: ASMR, age-standardized mortality rat\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003e2. Geographical Differences\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eFigure 1 shows the distributions of the global ASIRs, ASDRs, and ASMRs among MM patients in 1990 and 2021. Figure 1(A) and (B) show the countries with the highest ASIRs in 2021 were Australia, Italy, France, Germany, Austria, the Czech Republic, the United Kingdom (UK), Ireland, Sweden, Finland, Iceland, and the United States (US). The countries with the highest ASIRs in 1990 were the US, Canada, Australia, and New Zealand. Figure 1(C) and (D) show the countries with the highest ASDRs in 2021 were Australia, New Zealand, Namibia, Zimbabwe, Sweden, Finland, Norway, Poland, the Czech Republic, Austria, the UK, and Iceland. The countries with the highest ASDRs in 1990 were Australia, the US, Canada, Finland, Sweden, and Norway. Figure 1(E) and (F) show the countries with the highest ASMRs in 2021 were Australia, New Zealand, Namibia, Zimbabwe, North Macedonia, Croatia, Slovenia, Austria, the Czech Republic, Poland, Latvia, Estonia, Norway, Sweden, Finland, the UK, and the Netherlands. The countries with the highest ASMRs in 1990 were Australia, New Zealand, Namibia, the Czech Republic, Austria, Hungary, Croatia, Serbia, Norway, Sweden, and the US.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eFigure 1\\u003c/strong\\u003e. Global distribution of the ASIR, ASDR, and ASMR of malignant melanoma in 1990 and 2021\\u003c/p\\u003e\\n\\u003cp\\u003e(A) Worldwide distribution of malignant melanoma ASIRs in 1990\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003e(B) Worldwide distribution of malignant melanoma ASIRs in 2021\\u003c/p\\u003e\\n\\u003cp\\u003e(C) Worldwide distribution of malignant melanoma ASDRs in 1990\\u003c/p\\u003e\\n\\u003cp\\u003e(D) Worldwide distribution of malignant melanoma ASDRs in 2021\\u003c/p\\u003e\\n\\u003cp\\u003e(E) Worldwide distribution of malignant melanoma ASMRs in 1990\\u003c/p\\u003e\\n\\u003cp\\u003e(F) Worldwide distribution of malignant melanoma ASMRs in 2021\\u003c/p\\u003e\\n\\u003cp\\u003eFigure 2 shows social development levels of 204 GBD countries and their corresponding ASIRs, ASDRs, and ASMRs of MM in 2021. Figure 2(A) shows that the five countries with the highest MM ASIRs from highest to lowest were New Zealand (38.9%, 95% CI: 42.4-35.2), Australia (31.2%, 95% CI: 34.2-28.2), Norway (23, 95% CI: 24.8-21.2), the Netherlands (21.6%, 95% CI: 23.2-19.7), and Denmark (19.7%, 95% CI: 21.4-17.9). Figure 2(B) shows that the five countries with the highest MM ASDRs from highest to lowest were New Zealand (124.6%, 95% CI: 135.2-113.1), Australia (107.2%, 95% CI: 118.4-97.3), Norway (94.6%, 95% CI: 101.4-88.4), North Macedonia (86.9%, 95% CI: 122.7-50.6), and the Netherlands (80.9%, 95% CI: 87.4-74.7). Figure 2(C) shows that the five countries with the highest MM ASMRs from highest to lowest were New Zealand (4.3%, 95% CI: 4.7-3.9), Australia (3.8%, 95% CI: 4.2-3.4), Norway (3.4%, 95% CI: 3.6-3.1), North Macedonia (3.3%, 95% CI: 4.4-2), and Namibia (2.9%, 95% CI: 4.5-1.9).\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eFigure 2\\u003c/strong\\u003e. Social development levels of the 204 GBD countries in 2021 and the corresponding ASIRs, ASDRs, and ASMRs of malignant melanoma.\\u003c/p\\u003e\\n\\u003cp\\u003e(A) ASIRs\\u003c/p\\u003e\\n\\u003cp\\u003e(B) ASDRs\\u003c/p\\u003e\\n\\u003cp\\u003e(C) ASMRs\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003e3. Temporal trends\\u0026nbsp;\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eFigure 3 shows the temporal trends in MM burden from 1990 to 2021 globally and in five regions with different SDI scores. Figure 3(A) relevels the global EAPC of the high-middle-SDI regions was the highest, at 1.9% (95% CI: 1.6%-2.1%). The next highest EAPC was that of the high-SDI regions, at 0.8% (95% CI: 0.4-1.2%). ASIRs among women in high-middle-SDI regions were greater than those of men in all study years. In Figure 3(B), the global ASDR of the high-SDI regions decreased the most, with EAPCs of -0.7%（95% CI: -0.8--0.5）. The next highest ASDR was that of the high-middle-SDI regions (-0.3% (95% CI: -0.5-0.2%)). In Figure 3(C), the global ASMR of the high-SDI regions decreased the most, with an EAPC of -0.5% (95% CI: -0.7-0.3%), while the low-middle-SDI regions increased the most, with an EAPC of 0.5% (0.5-0.5%). The ASMRs among women in high-middle-SDI regions were greater than those among men in all study years.\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eFigure 3\\u003c/strong\\u003e. Age-standardized incidence rates, age-standardized DALYs, and age-standardized mortality rates among malignant melanoma patients in five regions with different SDI scores, globally, and by sex from 1990 to 2021, with time trends\\u003c/p\\u003e\\n\\u003cp\\u003e(A) Age-standardized incidence rates\\u003c/p\\u003e\\n\\u003cp\\u003e(B) Age-standardized DALYs\\u003c/p\\u003e\\n\\u003cp\\u003e(C) Age-standardized mortality rates\\u003c/p\\u003e\\n\\u003cp\\u003eFigure 4 shows the temporal trends of the annual ASIRs, ASDRs, and ASMRs for MM in 21 GBD regions from 1990 to 2021. Figure 4(A) shows that the ASIRs in Australia, high-income North America, and Western Europe increased and then decreased over the past 31 years, but the morbidity levels remained relatively high. In contrast, the ASIRs in Eastern Europe, Central Europe, and Central Asia gradually increased over the past 31 years. Overall, high morbidity still exists in countries with high SDI scores. Figure 4(B) shows that the ASDRs in Australia and high-income North America decreased over time, with Australia having the highest ASDR among all regions. The ASDR in Western Europe first increased and then decreased. Overall, a high ASDR was still observed in countries with high SDI scores, but the ASDR markedly decreased with increasing SDI scores. Figure 4(C) shows that although the ASMR in Australia decreased continuously over the past 31 years, it was still the highest among all regions in 2021. The ASMRs in high-income North America, Western Europe, and southern Latin America showed an upwards trend followed by a downwards trend. Overall, a high ASMR was still observed in regions with high SDI scores, but the ASMR mortality rate markedly decreased with increasing SDI scores.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eFigure 4\\u003c/strong\\u003e. Time trends of social development levels and the corresponding ASIRs, ASDRs, and ASMRs of malignant melanoma in 21 GBD countries from 1990 to 2021\\u003c/p\\u003e\\n\\u003cp\\u003e(A) ASIRs\\u003c/p\\u003e\\n\\u003cp\\u003e(B) ASDRs\\u003c/p\\u003e\\n\\u003cp\\u003e(C) ASMRs\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003e4. Age and gender distribution patterns\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eFigure 5 shows the estimated global ASIR, ASDR, and ASMR distributions and trends by age and gender. Figure 5(A) and (B) show that the incidence rate of MM among female patients aged 15-49 years was higher than that among male patients worldwide in 2021, while the incidence rate among male patients aged 55-89 years surpassed that among female patients. For female patients, the ASIR increased with age globally. Among male patients, the incidence rate increased before the age of 90 and decreased after. Figure 5(C) and (D) show that in 2021, the disability rate was higher among female patients aged 15-29 worldwide than male patients, while it was higher among male patients aged 30-89 than female patients. The disability rate of female patients increased with age, whereas for male patients it increased before the age of 94 and decreased after that. In 1990, the disability rate among female patients aged 20-29 worldwide exceeded that of male patients, while for those aged 30-74 it was higher in males than females. Both genders\\u0026apos; disability rates increased with age in 1990. Figure 5(E) and (F) show that in 2021, ASMR rates increased with age for both females and males worldwide. Among those aged 15-29, females had higher ASMR rates than males, while among those aged 30-89, males had higher rates than females; and among those aged 90 or older, females had higher rates than males. In 1990, ASMR rates also increased with age for both genders.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eFigure 5\\u003c/strong\\u003e. Distribution characteristics and trends of the global ASIR, ASDR, and ASMR among malignant melanoma patients by age group and sex in 1990 and 2021\\u003c/p\\u003e\\n\\u003cp\\u003e(A) Global distribution of the ASIRs of MM in 1990\\u003c/p\\u003e\\n\\u003cp\\u003e(B) Global distribution of the ASIRs of MM in 2021\\u003c/p\\u003e\\n\\u003cp\\u003e(C) Global distribution of the ASDRs of MM in 1990\\u003c/p\\u003e\\n\\u003cp\\u003e(D) Global distribution of the ASDRs of MM in 2021\\u003c/p\\u003e\\n\\u003cp\\u003e(E) Global distribution of the ASMRs of MM in 1990\\u003c/p\\u003e\\n\\u003cp\\u003e(F) Global distribution of the ASMRs of MM in 2021\\u003c/p\\u003e\\n\\u003cp\\u003eError bars indicate the 95% UIs for the global ASIRs, ASDRs, and ASMRs.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003e5. Forecasts for the forthcoming two decades\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eFigure 6 shows the incidence of MM in the next 20 years is expected to remain stable, with a slight downward trend, while the mortality rate is anticipated to decline significantly.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eFigure 6\\u003c/strong\\u003e. Predicted age-standardized incidence and mortality rates of malignant melanoma over the next 20 years\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003e(A) Age-standardized incidence rate\\u003c/p\\u003e\\n\\u003cp\\u003e(B) Age-standardized mortality rate\\u003c/p\\u003e\"},{\"header\":\"Discussion\",\"content\":\"\\u003cp\\u003eOur main findings were as follows: (1) The global incidence rate of MM increased from 1990 to 2021, while the ASDR and ASMR decreased during the same period. （2）The highest ASIR, ASDR, and ASMR was observed in high-SDI countries. (3) Australia remained the region with the highest ASIR, ASDR, and ASMR. (4) older adult males, particularly those over the age of 50, should intensify efforts in the prevention and management of MM. (5) The incidence of MM is predicted to remain stable over the next 20 years, while the mortality rate will significantly decline.\\u003c/p\\u003e\\n\\u003cp\\u003eThe increasing trend in the global incidence of MM from 1990 to 2021 can be attributed to demographic aging and improved detection rates. The high incidence rate of MM in regions with high socio-demographic index (SDI) may be linked to a higher proportion of individuals with reduced skin pigmentation and increased susceptibility to ultraviolet radiation [15]. Furthermore, the notable EAPCs observed in middle-SDI regions, Western Europe, the Middle East, and South Africa underscore the need for enhanced preventive measures. Notably, Australia, New Zealand, the US, and European countries exhibited the highest ASIRs in 2021; however, their declining trends could be associated with proactive interventions such as self-examination practices, public education initiatives, and advancements in multitherapy options over recent decades. Moreover, northern US regions demonstrated relatively high incidence and prevalence rates of MM warranting intensified prevention efforts [16]. It is noteworthy that only about 40% of Americans report adherence to recommended sun protection measures [17].\\u003c/p\\u003e\\n\\u003cp\\u003eFor the DALYs of MM, the global average decreased continuously from 1990 to 2021. Both high-SDI regions and low-middle-SDI regions need more prevention and control of MM-related disabilities as the former had a higher-level ASDR and the latter has been increasing in ASDR. Nationally, New Zealand, Australia, and Norway were among the three countries with the highest age-standardized DALYs.\\u0026nbsp;A retrospective cohort study utilized the U.S. administrative claims database (Truven Health MarketScan\\u0026reg;) to determine the incidence, timing, and cost of short-term disability (STD) and long-term disability (LTD) among adult patients with advanced melanoma. The study identified 1,052 patients with a late-stage melanoma diagnosis between 2011 and 2012, of whom 14 and 9 transitioned to STD and LTD, respectively. During the STD period, the average number of treatment days (from the start of treatment to the date of drug supply end or expected clinical benefit) was 16.4 days for patients receiving treatment, and 25.1 days for patients not receiving treatment. Among the 14 STD and 5 LTD patients with return-to-work records, the average time to return to work was 85.6 days and 76.4 days, respectively [18].\\u0026nbsp;The reduction in DALYs may be due to increased awareness of prevention and treatment, improved care quality, and the widespread use of innovative drugs. A study found that the overall quality care index (QCI) for melanoma has increased from 82.81 in 1990 to 91.29 in 2019. There is a positive correlation with socioeconomic status, with higher QCI scores. Australia has the highest QCI score (99.96), while the Central African Republic and Kiribati have the lowest. There has been a significant improvement in QCI for China and Saudi Arabia, while QCI has declined in North Korea, Zimbabwe, and Guam from 1990 to 2019[19].\\u0026nbsp;According to a European study from 2017 to 2018, the report found that 19 countries (55.8%) fully reimbursed the recommended BRAFi + MEKi combination therapy and anti-PD1 immunotherapy for melanoma treatment, while 17 countries (50%) fully covered the combination of anti-CTLA4 + anti-PD1 therapy. The study also reflects the relationship between global accessibility of innovative drugs for advanced melanoma treatment and economic and healthcare system performance [20].\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003eThe global ASMR of MM decreased continuously from 1990 to 2021.\\u0026nbsp;Compared with previous studies, Yuan Jin et al. [21] reported that the total mortality rate of MM globally decreased from 1990 to 2019. The mortality rate of people under 77.5 years old also decreased. A European study, including data from 123,360 cases of aggressive melanoma, found that death rates were generally declining in most European countries, with a few exceptions [22]. The observed trend of decreasing mortality rates among MM patients in certain countries is consistent with the findings of this study. The US has experienced a significant decrease in both the ASDR and ASMR, which may be due to the approval of 10 new targeted or immunotherapy drugs since 2011[23]. Australia\\u0026apos;s primary prevention measures, such as providing education on sun protection, have increased the use of sunscreen and may curbed death rates of MM since 1988[3].\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003eRegarding sex and age differences, for women, ASIR, ASDR, and ASMR all increased with age; for men, ASIR, ASDR, and ASMR increased with age, but after reaching a certain age, the ASIR (\\u0026gt;85 years) and ASDR (\\u0026gt;90 years) tended to stabilize or decrease. Compared with previous reports, Urban Katelyn et al. [24] revealed that the incidence of MM in females was greater before the age of 50 years, and the trend reversed from the age of 50 to 85 years. Male mortality was greater at all ages. Raimondi et al. [25] reported the incidence rate of MM is greater among teenagers and young women than among men. The incidence rate reversed at the age of 40 years, with the incidence of melanoma in males being greater than that in females. Buja et al. [26] reported that MM is more common in young adult women and older adult men. The standardized incidence rate of females was greater than males before the age of 50 years and after the age of 90 years. Zhang et al. [27] reported the ASR of the skin cancer burden among males was greater than that among females. The age-specific rate of the global skin cancer burden was greater in the elderly population, and an upwards trend was observed in the 55 years+ age group. These findings exhibited variability, yet consistently suggested that older adult males, particularly those over the age of 50, should intensify efforts in the prevention and management of MM.\\u003c/p\\u003e\\n\\u003cp\\u003eThe limitations of this study are as follows: (1) The absence of disease burden data related to MM subtypes or its risk factors in GBD 2021 impedes a comprehensive understanding of the contributors to MM and hampers the development of targeted and effective measures for prevention and control. (2) GBD 2021 employs sophisticated statistical models for estimating disease burden, introducing potential uncertainties in assumptions and parameter selection that may impact the accuracy and reliability of estimated results. (3) Regional variations in cancer registration practices may lead to underreporting of MM.\\u003c/p\\u003e\"},{\"header\":\"Conclusion\",\"content\":\"\\u003cp\\u003eIn summary, this study revealed that the global ASIR of MM increased from 1990 to 2021, accompanied by a decrease in the ASDR and ASMR during the same period. High-SDI countries such as Australia and New Zealand, high-income North America, some European countries remain higher in ASIR, ASDR, and ASMR. It is imperative for older adult males to intensify efforts in preventing and controlling MM.\\u003c/p\\u003e\"},{\"header\":\"Declarations\",\"content\":\"\\u003ch2\\u003eCompeting interests:\\u003c/h2\\u003e \\u003cp\\u003ethe authors declare no potential conflicts of interest.\\u003c/p\\u003e \\u003ch2\\u003ePatient consent\\u003c/h2\\u003e \\u003cp\\u003eNot applicable.\\u003c/p\\u003e \\u003ch2\\u003eFunding Source:\\u003c/h2\\u003e \\u003cp\\u003eThis work was supported by Anhui Provincial Key Research and Development Program Project (202104j07020048).\\u003c/p\\u003e\\u003ch2\\u003eAuthor Contribution\\u003c/h2\\u003e\\u003cp\\u003eLing Yao, Huashang Li, Guixiang Qian contributed equally to this work and are joint senior authors. Xiaoqiang Jia conceived and designed the study. Longfang Quan and Xuedi Lei supervised the study. Jie Dai and Qiuling Liu performed the statistical analysis. All authors contributed to the acquisition, analysis, or interpretation of data. Ling Yao, Huashang Li, Guixiang Qian and Zhuhui Zhang drafted the manuscript. All authors revised the report and approved the final version before submission. Yonghai Li is the guarantor and attests that all listed authors meet authorship criteria and that no others meeting the criteria have been omitted.\\u003c/p\\u003e\\u003ch2\\u003eData Availability\\u003c/h2\\u003e\\u003cp\\u003eData is provided within the manuscript or supplementary information files.\\u003c/p\\u003e\"},{\"header\":\"References\",\"content\":\"\\u003col\\u003e\\u003cli\\u003e\\u003cspan\\u003eLopes, J., Rodrigues, C. M., Gaspar, M. M. \\u0026amp; Reis, C. P. Melanoma management: from epidemiology to treatment and latest advances. Cancers.;14:4652. 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Global, regional and national incidence, mortality and disability-adjusted life‐years of skin cancers and trend analysis from 1990 to 2019: an analysis of the Global Burden of Disease Study 2019. \\u003cem\\u003eCancer Med.\\u003c/em\\u003e \\u003cb\\u003e10\\u003c/b\\u003e, 4905\\u0026ndash;4922 (2021).\\u003c/span\\u003e \\u003cspan\\u003e\\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003ehttps://doi.org/10.1002/cam4.4046\\u003c/span\\u003e\\u003cspan address=\\\"10.1002/cam4.4046\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e\\u003c/ol\\u003e\"}],\"fulltextSource\":\"\",\"fullText\":\"\",\"funders\":[],\"hasAdminPriorityOnWorkflow\":false,\"hasManuscriptDocX\":true,\"hasOptedInToPreprint\":true,\"hasPassedJournalQc\":\"\",\"hasAnyPriority\":false,\"hideJournal\":true,\"highlight\":\"\",\"institution\":\"\",\"isAcceptedByJournal\":false,\"isAuthorSuppliedPdf\":false,\"isDeskRejected\":\"\",\"isHiddenFromSearch\":false,\"isInQc\":false,\"isInWorkflow\":false,\"isPdf\":false,\"isPdfUpToDate\":true,\"isWithdrawnOrRetracted\":false,\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"researchsquare\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":true,\"externalIdentity\":\"\",\"sideBox\":\"\",\"snPcode\":\"\",\"submissionUrl\":\"/submission\",\"title\":\"Research Square\",\"twitterHandle\":\"researchsquare\",\"acdcEnabled\":true,\"dfaEnabled\":false,\"editorialSystem\":\"\",\"reportingPortfolio\":\"\",\"inReviewEnabled\":false,\"inReviewRevisionsEnabled\":true},\"keywords\":\"Malignant melanoma, epidemiological features, incidence, DALYs, mortality, sociodemographic index\",\"lastPublishedDoi\":\"10.21203/rs.3.rs-5813672/v1\",\"lastPublishedDoiUrl\":\"https://doi.org/10.21203/rs.3.rs-5813672/v1\",\"license\":{\"name\":\"CC BY 4.0\",\"url\":\"https://creativecommons.org/licenses/by/4.0/\"},\"manuscriptAbstract\":\"\\u003cp\\u003e\\u003cstrong\\u003eOBJECTIVE\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eMalignant melanoma, one of the most metastatic human cancers, is on the rise globally. However, its low prevalence leads to insufficient concern and its latest worldwide burden remains unclear. This study aims to update its epidemiological features to prompt timely and impactful interventions.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eMETHODS\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eWeanalysed malignant melanoma incidence, disability-adjusted life years (DALYs), and mortality trends from 1990 to 2021 across 204 countries using GBD 2021 data. We also projected incidence and mortality rates for the next two decades.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eRESULTS\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eGlobally, the age-standardized incidence rate (ASIR) of malignant melanoma in 2021 was 3.6 per 100,000 people with the estimated annual percentage change (EAPC) of the ASIR from 1990–2021 was 0.6%. The age-standardized DALYs rate (ASDR) of malignant melanoma in 2021 was 19.6 per 100,000 people with the ASDR EAPC from 1990 to 2021 was -0.7%. The age-standardized mortality rate（ASMR）of malignant melanoma in 2021 was 0.7 per 100,000 people with the ASMR EAPC from 1990 to 2021 was -0.4%. Australia remained the region with the highest ASIR, ASDR, and ASMR in 2021. Older adult males had higher rates than females for all three measures.\\u003c/p\\u003e\\n\\u003cp\\u003eThe incidence of MM is predicted to remain stable over the next twenty years while the mortality rate will significantly decline.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eCONCLUSION\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThe global ASIR of malignant melanoma increased from 1990 to 2021, while the ASDR and ASMR decreased during the same period. High-SDI countries and older adult males require enhanced measures for the prevention and control of malignant melanoma.\\u003c/p\\u003e\",\"manuscriptTitle\":\"Epidemiological Characteristics and Temporal Trends of Malignant Melanoma from 1990 to 2021, with Projections until 2044\",\"msid\":\"\",\"msnumber\":\"\",\"nonDraftVersions\":[{\"code\":1,\"date\":\"2025-02-06 10:50:06\",\"doi\":\"10.21203/rs.3.rs-5813672/v1\",\"editorialEvents\":[{\"type\":\"communityComments\",\"content\":0}],\"status\":\"published\",\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"researchsquare\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":true,\"externalIdentity\":\"\",\"sideBox\":\"\",\"snPcode\":\"\",\"submissionUrl\":\"/submission\",\"title\":\"Research Square\",\"twitterHandle\":\"researchsquare\",\"acdcEnabled\":true,\"dfaEnabled\":false,\"editorialSystem\":\"\",\"reportingPortfolio\":\"\",\"inReviewEnabled\":false,\"inReviewRevisionsEnabled\":true}}],\"origin\":\"\",\"ownerIdentity\":\"c06e61a2-6efa-495f-883f-a60b1890a27a\",\"owner\":[],\"postedDate\":\"February 6th, 2025\",\"published\":true,\"recentEditorialEvents\":[],\"rejectedJournal\":[],\"revision\":\"\",\"amendment\":\"\",\"status\":\"posted\",\"subjectAreas\":[{\"id\":43812858,\"name\":\"Health sciences/Diseases/Cancer\"},{\"id\":43812859,\"name\":\"Health sciences/Diseases/Skin diseases\"},{\"id\":43812860,\"name\":\"Health sciences/Oncology/Cancer/Cancer epidemiology\"},{\"id\":43812861,\"name\":\"Health sciences/Oncology/Cancer/Cancer prevention\"},{\"id\":43812862,\"name\":\"Health sciences/Oncology/Cancer/Skin cancer\"},{\"id\":43812863,\"name\":\"Health sciences/Medical research/Epidemiology\"}],\"tags\":[],\"updatedAt\":\"2025-10-23T10:38:14+00:00\",\"versionOfRecord\":[],\"versionCreatedAt\":\"2025-02-06 10:50:06\",\"video\":\"\",\"vorDoi\":\"\",\"vorDoiUrl\":\"\",\"workflowStages\":[]},\"version\":\"v1\",\"identity\":\"rs-5813672\",\"journalConfig\":\"researchsquare\"},\"__N_SSP\":true},\"page\":\"/article/[identity]/[[...version]]\",\"query\":{\"redirect\":\"/article/rs-5813672\",\"identity\":\"rs-5813672\",\"version\":[\"v1\"]},\"buildId\":\"8U1c8b4HqxoKbykW_rLl7\",\"isFallback\":false,\"isExperimentalCompile\":false,\"dynamicIds\":[84888],\"gssp\":true,\"scriptLoader\":[]}","source_license":"CC-BY-4.0","license_restricted":false}