Global, regional, and national childhood brain and central nervous system cancer burden: An analysis based on the Global Burden of Disease Study

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Methods We utilized data from the 2021 Global Burden of Disease Study, we analyzed trends in childhood brain and central nervous system cancer through joinpoint regression. We assessed the global burden of childhood brain and central nervous system cancer from various perspectives. Lastly, The Bayesian age-period-cohort model was employed to forecast future trends through 2030 Results Childhood brain and CNS cancers are the most common solid tumors and the leading cause of death in children. From 1990 to 2021, age-standardized incidence, prevalence, mortality, and DALYs have shown a decreasing trend. The incidence is slightly higher in boys than in girls and peaking at ages 0–4 years, decreasing with age. The disease burden correlates with socio-demographic indices, with higher burdens observed in regions with higher socio-demographic indices. Future projections indicate a continued decline in incidence, prevalence, mortality, and DALYs. Conclusions While the global burden of childhood brain and CNS cancer has significantly decreased due to medical advancements, it continues to be a major cause of childhood mortality. Further optimization of global health resources is crucial to alleviating this burden. Epidemiology central nervous system cancer children global burden of disease Prediction Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Figure 7 Figure 8 1. Introduction Childhood brain and central nervous system (CNS) cancers are the most common solid tumors in children and the leading cause of childhood mortality, particularly in developed countries 1 – 4 . These cancers are often diagnosed late and are associated with a poor prognosis 5 , 6 . Brain and CNS cancers encompass tumors of the brain and spinal cord, with brain tumors constituting over 90% of cases 7 . Research indicates that the incidence of these cancers in children decreases with age, with the highest incidence occurring in the 0–4 year age group 1 , 8 , 9 . Malignant tumors constitute approximately 30% of childhood brain and CNS cancers. Gliomas and germ cell tumors are more common in boys, whereas pituitary tumors and meningiomas are more prevalent in girls 7 . Brain and CNS cancers typically present with nonspecific symptoms, such as headaches and dizziness. In children, these symptoms often manifest as poor learning and fatigue. The nonspecific nature of these symptoms often leads to the disease being overlooked 10 . Despite recent improvements in prognosis due to advances in medical science, updated therapeutic guidelines, and targeted molecular therapies, childhood brain and CNS cancers continue to represent a substantial global health challenge 11 – 15 . Therefore, it is crucial to assess the specific burden of childhood brain and CNS cancers to inform efforts to mitigate this global health issue. The Global Burden of Disease Study (GBD) 2021 (the latest year) provides four key metrics to assess the burden, covering data from 204 countries and territories across various regions 16 . Using the latest GBD 2021 data, we analyzed the burden and trends of childhood brain and CNS cancers at the global, regional, national, and local levels from 1990 to 2021. 2. Method 2.1 Study population Brain and CNS cancer data, as defined by the GBD project, were collected for both sexes across three age categories (< 5 years, 5–9 years, 10–14 years) and from 204 national and regional subcategories. We categorized children as 0–14 years old and divided them into three age subcategories: <5 years, 5–9 years, and 10–14 years, to better analyze age-related differences. All countries and territories were categorized into 21 regions based on epidemiological similarities and geographical proximity. 2.2 Data collection We analyzed data from the Global Burden of Disease (GBD) Study 2021 ( https://ghdx.healthdata.org/gbd-2021/sources ). This dataset encompasses information on 369 diseases and injuries, including brain and CNS cancer, across 204 countries and territories from 1990 to 2021. In this study, we extracted data on the incidence, prevalence, mortality and DALYs of the brain and central nervous system cancers in individuals aged 0–14 years from the GBD 2021 through the GBD Results Tool ( https://vizhub.healthdata.org/gbdresults/ ). Incident cases, prevalent cases, deaths, disability-adjusted life years (DALYs), incidence, and prevalence rates were extracted directly from GBD 2021, with all rates reported per 100,000 population. The 95% uncertainty interval (UI) was determined by the 25th and 95th percentiles of the 1,000 estimates generated by the GBD algorithm. 2.3 Sociodemographic index GBD 2021 also provided the Social Demographic Index (SDI) for each country, a composite measure reflecting social and economic conditions that influencing health outcomes. The SDI is calculated as the geometric mean of three indices (scaled from 0 to 1): total fertility rate among individuals under 25, average years of education for individuals aged 15 and older, and lag-distributed income per capita. An SDI of 0 indicates minimal education, low per capita income, and high fertility rates. The SDI is divided into five quintiles: low, lower-middle, middle, upper-middle, and high regions. 2.4 Statistical analysis We calculated age-standardized rates (ASRs) per 100,000 people of brain and CNS cancer from 0 to 14 years, according to the formula: $$\:\frac{{\varSigma\:}_{i=1}^{N}{\alpha\:}_{i}{W}_{i}}{{\varSigma\:}_{i=1}^{N}{W}_{i}}$$ In the equation, \(\:{\alpha\:}_{i}\) represents the age-specific rate in the \(\:i\) th age group, while \(\:{W}_{i}\) denotes the count of individuals within the same age group based on the GBD 2021 standard population. \(\:N\) is the total of age categories. The primary objective of this study was to analyze global trends in the incidence, prevalence, mortality, and DALYs associated with childhood brain and CNS cancer. We computed the average annual percentage change (AAPC) for these metrics across the 0–14 age group and its three subcategories using linear regression models. The AAPC summarizes trends over a specified interval, computed as a weighted average of annual percentage change (APC), allowing a single value to represent the average trend over multiple years. AAPC was determined using the geometrical weighted average of APCs. The AAPC value represents the annual rate of variation; for example, an AAPC of 0.5 indicates an yearly increase of 0.5%. The second aim was to determine periods with significant changes in the incidence, prevalence, mortality, and DALYs trends for childhood brain and CNS cancer. To fulfill this goal, we applied Joinpoint Regression Analysis to detect temporal changes and fit the most parsimonious model by connecting separate line segments on a logarithmic scale. These portions known as joinpoints mark changes in trend. The final model based on professional judgment and the Weighted Bayesian Information Criterion within the Joinpoint software. We then examined trends in incidence, prevalence, mortality, and DALYs by age, sex, five SDI regions, 21 GBD regions, and 204 countries. Tendencies were plotted by SDI index across the 21 GBD regions and 204 countries. Finally, we projected the incidence, prevalence, mortality, and DALYs of childhood brain and CNS cancer for 2030 projections were made using the Bayesian age-period-cohort model. All statistical analyses were performed using RStudio (version 2024.4.2.0) and the Joinpoint Regression Program (version 4.9.1.0). 3. Result 3.1 Age-standardized global Trends Globally, the incidence of childhood brain and CNS cancer exhibited a general decline from 1990 to 2021 (AAPC = -0.52, 95% CI [-0.62, -0.42]). Joinpoint regression analysis recognized marked shifts in incidence rates during 1997, 2005, and 2019. The incidence rate experienced a slight decline from 1990-1997 (AAPC = -0.02, 95% UI [-0.22, 0.17]), a marked decline between 1998-2005 (AAPC = -1.56, 95% UI [-1.72, -1.39]), an increase from 2006-2019 (AAPC = 0.43, 95% UI [0.37, 0.49]), and a significant decline after 2020 (AAPC = -4.67, 95% UI [-5.90, -3.41]). Joinpoint regression also recognized marked shifts in the disease prevalence in 2000, 2004, and 2019. While there was a decline in prevalence between 2000-2004 and post-2019 (AAPC = -1.17, 95% UI [-1.89, -0.44]; AAPC = -4.96, 95% UI [-6.61, -3.29]), the overall trend from 1990 to 2021 showed a uptick (AAPC = 0.27, 95% CI [0.12, 0.42]). As shown in Fig.1 and Table 1-2. From 1990 to 2021, both the mortality and DALYs for the disease dispalyed a consistent decline (AAPC = -1.44, 95% UI [-1.57, -1.31]; AAPC = -1.46, 95% CI [-1.59, -1.33]). Joinpoint regression analysis showed significant changes in mortality rates and DALYs during 1997, 2006, and 2018. As shown in Fig.1 and Table 1-2. 3.2 Age-standardized global trends by sex Globally, the incidence of brain and CNS cancer has been declining in both boys and girls. Incidence rates dropped from 2.03 per 100,000 (95% UI [1.28, 2.87]) and 1.76 per 100,000 (95% UI [1.21, 2.58]) to 1.67 per 100,000 (95% UI [1.13, 2.27]) in boys, and from 1.63 per 100,000 (95% UI [1.35, 1.91]) in girls. The AAPC was -0.68 (95% CI [-0.82, -0.53]) for boys and -0.32 (95% CI [-0.42, -0.22]) for girls. Although exhibited a higher incidence in boys than in girls, the gap between the sexes is gradually narrowing. From 1990 to 2021, there was an upward trend in the prevalence of the disease in both boys and girls. Prevalence increased from 7.58 per 100,000 (95% UI [5.09, 10.38]) in boys and 6.96 per 100,000 (95% UI [5.02, 9.67]) in girls in 1990, to 8.17 per 100,000 (95% UI [5.56, 11.00]) in boys and 8.09 per 100,000 (95% UI [6.61, 9.55]) in girls by 2021. The AAPC for prevalence was 0.19 (95% CI [0.02, 0.35]) for boys and 0.38 (95% CI [0.25, 0.52]) for girls. As shown in Fig.S1 and Table 1-2. Mortality rates and DALYs followed similar trends in both boys and girls, with a consistent decline. The AAPC for mortality was -1.66 (95% CI [-1.82, -1.49]) for boys and -1.22 (95% CI [-1.33, -1.13]) for girls. The AAPC regarding DALYs was -1.68 (95% CI [-1.84, -1.51]) for boys and -1.24 (95% CI [-1.36, -1.13]) for girls. As shown in Table 1-2. 3.3 Global trends by age group Globally, the incidence of brain and CNS cancer in children between the age of 10 and 14 years exhibited a rising trend from 1990 to 2021, growing from 1.36 per 100,000 (95% UI [1.10, 1.59]) in 1990 to 1.49 per 100,000 (95% UI [1.27, 1.80]) in 2021. The AAPC for this group was 0.29 (95% CI [0.14, 0.45]). In the other two age categories, the incidence exhibited a declining trend, with the most notable decrease observed in children under 5 years old, dropping from 2.47 per 100,000 (95% UI [1.81, 3.25]) in 1990 to 1.77 per 100,000 (95% UI [1.36, 2.25]) in 2021.The AAPC value was -1.2, (95% CI [-1.32, -1.07]). In the 5-9 year age group, the AAPC was -0.26 (95% CI [-0.45, -0.06]). As shown in Fig.S2 and Table 1-2. Mortality and DALYs trends were uniform across all three age categories, showing a declining trend. The most significant reduction in mortality occurred in children under 5 years, decreasing from 1.62 per 100,000 (95% UI [1.14, 2.18]) in 1990 to 0.86 per 100,000 (95% UI [0.64, 1.13]) in 2021, with an AAPC of -2.12 (95% CI [-2.26, -1.98]). The AAPC values for the 5-9 and 10-14 year age categories were -1.23 (95% CI [-1.38, -1.08]) and -0.65 (95% CI [-0.77, -0.53]), respectively. Similarly, the most marked reduction in DALYs was found in children under 5 years old. DALYs decreased from 143.38 (95% UI [101.31, 193.18]) in 1990 to 76.36 (95% UI [57.26, 99.81]) in 2021, with an AAPC of -2.11 (95% CI [-2.25, -1.97]). The AAPC values for the 5-9 and 10-14 year age categories were -1.22 (95% CI [-1.38, -1.07]) and -0.64 (95% CI [-0.76, -0.52]). As shown in Fig.S2 and Table 1-2. 3.4 Age-standardized global trends by SDI region We divided the globe into five regions on the basis of the SDI and compared childhood brain and CNS cancer incidence, mortality, and DALYs across these regions. The incidence of childhood brain and CNS cancer was more prevalent in the high and upper-middle SDI regions, while the low SDI region had the lowest incidence. Overall, incidence rates declined in all regions excluding the low and lower-middle SDI regions. The most notable decrease existed in the middle SDI region, where the incidence rate fell from 2.22 per 100,000 (95% UI [1.56, 2.76]) in 1990 to 1.99 per 100,000 (95% UI [1.51, 2.53]) in 2021, with an AAPC of -0.46 (95% CI [-0.68, -0.25]). In the upper-middle SDI region, the AAPC was -0.43 (95% CI [-0.70, -0.16]), while the high SDI region experienced only a mild reduction, with an AAPC of -0.09 (95% CI [-0.29, 0.10]). Notably, the incidence in the high SDI region surpassed that in the upper-middle SDI region for the first time in 2012. Regarding prevalence, the high SDI region consistently had the highest rates. Prevalence increased across all regions, with the most notable rise in the upper-middle SDI region, where it grew from 11.62 per 100,000 (95% UI [9.09, 14.11]) in 1990 to 16.34 per 100,000 (95% UI [12.74, 21.40]) in 2021, with an AAPC of 0.97 (95% CI [0.62, 1.32]). As shown in Fig.S3 and Table 3-4. Mortality rates and DALYs both showed significant declines, particularly in the upper-middle SDI region. Mortality rates diminish from 1.96 per 100,000 (95% UI [1.52, 2.38]) in 1990 to 0.96 per 100,000 (95% UI [0.79, 1.22]) in 2021, with an AAPC of -2.36 (95% CI [-2.60, -2.11]). DALYs decreased from 165.74 (95% UI [128.14, 201.99]) to 81.25 (95% UI [66.16, 103.25]), with an AAPC of -2.37 (95% CI [-2.62, -2.13]). As shown in Fig.S3 and Table 3-4. 3.5 Regional age-standardized burden of childhood brain and CNS cancer In 2021, East Asia had the greatest ASIR of childhood brain and CNS cancer, followed by High Income Asia Pacific. The greatest ASPR was noted in High Income Asia Pacific, with High Income North America ranking second. Central Asia had the highest ASMR and DALYs, followed by Andean Latin America. Since 1990, ASIRs have risen in over half of the regions, the most notable rise in Southern Sub-Saharan Africa. Prevalence rates have also increased in most regions, especially in North Africa and the Middle East. Mortality rates and DALYs have decreased in most regions, with the most significant reduction occurring in East Asia. Additionally, ASIR, ASPR, age-standardized rate of Mortality ASMR, and DALYs are generally higher for boys compared to girls in most regions, consistent with global trends. As shown in Fig.2. The burden of childhood brain and CNS cancer varies significantly by SDI. Higher SDI regions tend to have higher ASIR and ASPR. While ASIR and ASPR generally increase with higher SDI, regional patterns show considerable variation. Some regions exhibit declining ASIR and ASPR with rising SDI, while other indexes show increasing rates or no clear trend. Conversely, age-standardized death rates and DALYs consistently decrease with higher SDI, with higher SDI areas experiencing lower ASMR and DALYs. As shown in Fig.3. 3.6 National age-standardized trends In 2021, Monaco had the greatest ASIR of childhood brain and CNS cancer globally, with an incidence of 8.18 per 100,000 (95% UI [4.45, 13.41]). Conversely, Gambia had the least incidence at 0.15 per 100,000 (95% UI [0.07, 0.25]). Monaco also recorded the greatest ASPR at 58.25 per 100,000 (95% UI [31.61, 196.25]), while Gambia had the least prevalence rate of 0.49 per 100,000 (95% UI [0.22, 0.82]). As shown in Fig.4. For mortality rates and DALYs in 2021, Tajikistan reported the highest rates globally, with 2.93 per 100,000 (95% UI [1.46, 4.57]) for mortality and 249.10 (95% UI [123.31, 387.88]) for DALYs. In contrast, Cook Islands had the least rates, with 0.11 per 100,000 (95% UI [0.06, 0.18]) for mortality and 8.98 (95% UI [4.79, 15.32]) for DALYs. As shown in Fig.4. Between 1990 and 2021, Greenland saw the greatest decline in ASIR, with an AAPC of -2.04 (95% CI [-2.38, -1.70]). Luxembourg saw the greatest decrease in ASPR, with an AAPC of -2.41 (95% CI [-4.74, -0.02]). Luxembourg also had the largest reduction in ASMR, with an AAPC of -3.22 (95% CI [-3.95, -2.48]). Serbia experienced the greatest notable decline in DALYs, with an AAPC of -3.17 (95% CI [-3.69, -2.64]). As shown in Fig.5. The burden of childhood brain and CNS cancer varies significantly based on SDI. ASIR and ASPR increase with higher SDI values, showing a clear upward trend. However, ASMR and DALYs are highest in regions with SDI values between 0.625 and 0.75. As shown in Fig.6. 3.7 Forecasting trends in childhood brain and CNS cancer Figure 7 presents our forecast for future trends in childhood brain and CNS cancer. Our projections indicate a continued decline in all key metrics: incidence, prevalence, mortality, and DALYs. Specifically, ASIR is expected to decrease from 1.65 per 100,000 in 2021 to 1.24 per 100,000 by 2030. ASPR is projected to fall from 8.13 per 100,000 in 2021 to 5.91 per 100,000 in 2030. Similarly, the mortality rate is anticipated to drop from 0.82 per 100,000 in 2021 to 0.59 per 100,000 in 2030. DALYs are forecasted to decrease from 68.54 in 2021 to 50.15 in 2030. 4. Discussion 4.1 Main interpretation Childhood brain and CNS cancer is the most prevalent solid tumor in children aged 0–14 years 2 , with incidence rates decreasing as children age and being higher in boys compared to girls. The standard treatment for childhood gliomas typically involves complete surgical resection followed by radiotherapy, provided it is feasible. 14 . However, the complexities of intracranial surgery, along with the risks associated with cranial radiation and the toxicity of chemotherapeutic agents, can significantly impact children's brain development 5 , 17 . These challenges contribute to the relatively rare occurrence of childhood brain and CNS cancer, which remains among the three most prominent causes of childhood mortality. Consequently, it poses a substantial global health burden 1 , 3 , 11 . The latest GBD study indicates that in 2021, there will be 33,091 new cases of childhood brain and CNS cancer and 16,356 deaths worldwide. At present, there are 162,900 individuals with brain and CNS cancer and 1,371,300 DALYs. 16 . While the overall incidence of childhood brain and CNS cancer has been decreasing, there was a noticeable rebound between 2005 and 2019, as also observed by Miller et al. 18 This rebound may be attributed to the adoption of molecular diagnostic techniques, advancements in diagnostic methods, and improvements in disease registry follow-up. 15 , 19 , 20 . Previous research indicates that brain and CNS cancer is most common in children aged 0 to 4 years, with the highest mortality rates occurring within the first year of life. 1 , 2 , 9 . Recent advancements in prenatal diagnostic techniques and screening for tumor-susceptible syndromes have likely contributed to a decline in the incidence of this disease 2 , 21 . In line with earlier studies, our findings show a consistent decline in global mortality and DALYs for childhood brain and CNS cancers from 1990 to 2021 3 This trend can be attributed to the standardization of treatment protocols, improved grading of treatment intensity, and advancements in therapies such as tumor vaccines and lysoviruses 13 , 22 . Our analysis of data from 1990 to 2021 reveals a notable acceleration in the rate of decline in incidence and mortality after 2018. This improvement is likely linked to the updated WHO classification of CNS cancers, as well as advancements in technologies such as fluorescence lifetime imaging microscopy, pediatric cancer model atlases, and proton therapy 12 , 21 , 23 – 27 . Our projections suggest that the incidence, mortality, and DALYs of this disease will continue to decrease in the future. Significant differences were observed within the five SDI regions, with high and upper-high SDI areas reporting higher rates of incidence, survival, mortality, and DALYs for childhood brain and CNS cancers compared to other regions. Previous research supports the link between childhood brain and CNS cancer incidence and economic development levels 28 , with ionizing radiation being the only identified risk factor for these cancers 6 , 29 , High and middle-high SDI regions are exposed to higher levels of ionizing radiation 4 . Additionally, harmful substances such as carbon monoxide, butadiene and diesel vehicle emissions may also contribute to increased cancer rates 30 . Moreover, these areas benefit from more advanced healthcare systems and better screening tools, which further influence cancer incidence. While ASMR and DALYs are decreasing across all SDI regions, the lower availability of medical resources in lower-middle and low SDI regions leads to a slower decline in these metrics 3 , 8 . Among the 204 countries and regions analyzed, Africa shows relatively low rates of incidence and high rates of mortality for childhood brain and CNS cancers. This is likely due to the continent's lower socio-economic status 8 . Additionally, research indicates that black children have a lower incidence of brain and CNS cancers as opposed to white children, possibly due to inter-ethnic epigenetic differences 4 , 31 . Underdiagnosis also contributes to the lower reported prevalence in Africa, with some studies showing that up to 50% of cases in low-income areas are underdiagnosed 32 . Furthermore, black children with brain and CNS cancers generally experience higher mortality rates than white children, which helps explain the elevated mortality rates observed in Western Asian countries. 31 Unlike previous studies on childhood tumors, our research specifically examines brain and CNS cancers, incorporating the most recent data from 2020 and 2021. While we have made significant efforts to provide a thorough analysis, our study relies on secondary data from the GBD. 4.2 Limitation limitations in cancer registry systems in some regions may introduce bias, so our findings should be interpreted with caution. This study is dependent on secondary analysis based on existing database data, and the accuracy is to some extent dependent on the accuracy of the original data. 4.3 conclusion This study offers a comprehensive view of the global burden of childhood brain and CNS cancers from various angles. Despite progress in medical science and technology leading to a reduction in disease burden, substantial human, material, and financial resources remain necessary to address this issue annually. We hope this research will provide policymakers and encourage the effective allocation of global resources to further mitigate the impact of this disease. Abbreviations Brain and CNS cancer Brain and central nervous system cancer DALYs Disability-adjusted life years UI Uncertainty interval SDI Socio-demographic index GBD The Global Burden of Disease Study AAPC Average annual percentage change APC Annual percentage change ASIR Age-standardized incidence rate ASPR Age-standardized prevalence rate ASMR Age-standardized rate of Mortality Declarations Authorship contributions ZJ Su developed the concept and authored the main body of the article. Jie Lu conducted the data collection and analysis. YH Shi is responsible for visualizing data. ZS Guo, T Li and Bin Qi proofread, reviewed, and approved the final manuscript. Funding statement None. Data availability All data used in this study can be find at the GBD 2021 study (https://vizhub.healthdata.org/gbd-results). In the meantime, we have uploaded the data used in this article to the supplementary material. Consent for publication Not applicable Acknowledgments Data used for the analysis can be find at the Institute of Health Metrics and Evaluation (http://www.healthdata.org/; http://ghdx.healthdata.org/gbd-results-tool). We sincerely thank all the members of the Global Burden of Disease 2021 Collaborative Group for their commitment. Based on their work, we have analyzed and deepened our understanding of the burden of disease. Ethics approval The study passed the review of the Ethics Committee of the First Hospital of Jilin University (2024-328) and GBD website. Competing interests The author(s) declare no competing interests. Declaration of generative AI-assisted technologies in the writing process During the preparation of this work the authors used ChatGPT 4.0 to Check manuscripts for grammatical errors and improve the coherence and readability of the manuscript (excluding writing draft of manuscript, paragraph, or sentences, only for language polishing purpose). 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Tables Table 1.Global burden of childhood cancer in 2021 and its AAPC from 1990 to 2021 Incidence Prevalence Cases (n), 1990 Incidence (per 100 000 population), 1990 Cases (n), 2021 Incidence (per 100 000 population), 2021 AAPC, 1990-2021 p value Cases (n), 1990 Prevalence (per 100 000 population), 1990 Cases (n), 2021 Prevalence (per 100 000 population), 2021 AAPC, 1990-2021 p value Global 33107 (25238-41603) 1.90 (1.45-2.38) 33091 (26727-40701) 1.65 (1.33-2.03) -0.52 (-0.62 to -0.42) <0.001 127138 (99975-155213) 7.28 (5.73-8.88) 162879 (133143-199896) 8.13 (6.63-9.99) 0.27 (0.12 to 0.42) 0.001 sex Male 18166 (11497-25766) 2.03 (1.28-2.87) 17255 (11733-23502) 1.67 (1.13-2.27) -0.68 (-0.82 to -0.53) <0.001 68068 (45563-99223) 7.58 (5.09-10.38) 84536 (57733-113772) 8.17 (5.56-11.00) 0.19 (0.02 to 0.35) 0.026 Female 14942 (10289-21897) 1.76 (1.21-2.58) 15836 (13158-18474) 1.63 (1.35-1.91) -0.32 (-0.42 to -0.22) <0.001 59070 (42573-82199) 6.96 (5.02-9.67) 78343 (64131-92352) 8.09 (6.61-9.55) 0.38 (0.25 to 0.52) <0.001 Age group, years 0-4 15340 (11231-20140) 2.47 (1.81-3.25) 11617 (8947-14807) 1.77 (1.36-2.25) -1.2 (-1.32 to -1.07) <0.001 61472 (46312-78413) 9.92 (7.47-12.65) 59475 (46057-75035) 9.04 (7.00-11.40) -0.42 (-0.67 to -0.17) 0.001 5-9 10464 (8138-12932) 1.79 (1.39-2.22) 11509 (9336-13927) 1.68 (1.36-2.03) -0.26 (-0.45 to -0.06) 0.009 37752 (30360-45216) 6.47 (5.20-7.75) 53661 (44498-64794) 7.81 (6.48-9.43) 0.58 (0.34 to 0.81) <0.001 10-14 7304 (5869-8531) 1.36 (1.10-1.59) 9965 (8444-11967) 1.49 (1.27-1.80) 0.29 (0.14 to 0.45) <0.001 27915 (23302-31584) 5.21 (4.35-5.89) 49743 (42589-60067) 7.46 (6.39-9.01) 1.17 (1.00to 1.35) <0.001 Table 2. The mortality and DALYs of childhood cancer in 2021 and its AAPC from 1990 to 2021. Mortality DAYLs Cases (n), 1990 Mortality (per 100 000 population), 2019 Cases (n), 2021 Mortality (per 100 000 population), 2021 AAPC, 1990-2021 p value Cases (n), 1990 DAYLs (per 100 000 population), 1990 Cases (n), 2021 DAYLs (per 100 000 population), 2021 AAPC, 1990-2021 p value Global 22031 (16236-28461) 1.26 (0.93-1.63) 16356 (12828-20343) 0.82 (0.64-1.02) -1.44 (-1.57 to -1.31) <0.001 1863538 (1370838-2410914) 107.15 (78.82-138.63) 1371309 (1074065-1706987) 68.54 (53.58-85.48) -1.46 (-1.59 to -1.33) <0.001 sex Male 12539 (7545-18421) 1.40 (0.84-2.04) 8778 (5979-12030) 0.85 (0.58-1.16) -1.66 (-1.82 to -1.49) <0.001 1059678 (635296-1561078) 118.05 (70.88-173.68) 735204 (499629-1007972) 71.13 (48.20-97.64) -1.68 (-1.84 to -1.51) <0.001 Female 9492 (6226-14929) 1.12 (0.74-1.77) 7578 (6242-8819) 0.78 (0.64-0.91) -1.22 (-1.33 to -1.13) <0.001 803860 (525064-1271695) 94.72 (61.94-149.60) 636106 (523007-741090) 65.77 (53.98-76.75) -1.24 (-1.36 to -1.13) <0.001 Age group, years 0-4 10040 (7089-13544) 1.62 (1.14-2.18) 5660 (4242-7405) 0.86 (0.64-1.13) -2.12 (-2.26 to -1.98) <0.001 888845 (628041-1197591) 143.38 (101.31-193.18) 502601 (376859-656923) 76.36 (57.26-99.81) -2.11 (-2.25 to -1.97) <0.001 5-9 7235 (5447-9194) 1.24 (0.93-1.58) 5863 (4608-7130) 0.85 (0.67-1.04) -1.23 (-1.38 to -1.08) <0.001 603360 (453884-766573) 103.40 (77.78-131.37) 490210 (385233-595775) 71.35 (56.07-86.71) -1.22 (-1.38 to -1.07) <0.001 10-14 4756 (3701-5723) 0.89 (0.69-1.07) 4832 (3978-5808) 0.72 (0.60-0.87) -0.65 (-0.77 to -0.53) <0.001 371333 (288914-446749) 69.32 (53.93-83.40) 378499 (311973-454290) 56.78 (46.80-68.15) -0.64 (-0.76 to -0.52) <0.001 Table3. The incidence, prevalence of childhood brain and central nervous system cancer and their AAPCs from 1990 to 2021 in five SDI regions. Incidence Prevalence Cases (n), 1990 Incidence (per 100 000 population), 2019 Cases (n), 2021 Incidence (per 100 000 population), 2021 AAPC, 1990-2021 p value Cases (n), 1990 Prevalence (per 100 000 population), 1990 Cases (n), 2021 Prevalence (per 100 000 population), 2021 AAPC, 1990-2021 p value High 5191 (4920-5477) 2.80 (2.66-2.96) 4751 (4352-5172 2.74 (2.51-2.99) -0.09 (-0.29 to 0.10) 0.351 29869 (28179-31655) 16.14 (15.23-17.11) 32338 (29513-35287) 18.68 (17.02-20.40) 0.47 (0.14 to 0.80) 0.005 Upper-middle 8201 (6390-9979) 3.02 (2.35-3.68) 6298 (4957-8149) 2.74 (2.15-3.56) -0.43 (-0.70 to -0.16) 0.002 31518 (24691-38231) 11.62 (9.09-14.11) 37338 (29245-48755) 16.34 (12.74-21.40) 0.97 (0.62 to 1.32) <0.001 Middle 12792 (8959-15882) 2.22 (1.56-2.76) 11247 (8540-114246) 1.99 (1.51-2.53) -0.46 (-0.68 to -0.25) <0.001 44424 (30943-55336 7.72 (5.37-9.61) 55187 (41287-70926) 9.81 (7.31-12.66) 0.66 (0.42 to 0.91) <0.001 Lower-middle 5046 (3437-7807) 1.06 (0.72-1.63) 6890 (5226-8800) 1.19 (0.90-1.53) 0.40 (0.31 to 0.49) <0.001 15688 (10763-24166) 3.28 (2.25-5.04) 25370 (19078-32625) 4.41 (3.31-5.67) 0.95 (0.89 to 1.01) <0.001 Low 1851 (1093-3527) 0.78 (0.46-1.47) 3881 (2609-5212) 0.84 (0.56-1.12) 0.26 (0.05 to 0.47) 0.014 5543 (3262-10675) 2.31 (1.36-4.41) 12543 (8366-16894) 2.70 (1.80-3.64) 0.50 (0.35 to 0.64) <0.001 Table 4. The mortality and DALYs of childhood brain and central nervous system cancer and their AAPCs from 1990 to 2021 in five SDI regions. Mortality DALYs Cases (n), 1990 Mortality (per 100 000 population), 1990 Cases (n), 2021 Mortality (per 100 000 population), 2021 AAPC, 1990-2021 p value Cases (n), 1990 DALYs (per 100 000 population), 1990 Cases (n), 2021 DALYs (per 100 000 population), 2021 AAPC, 1990-2021 p value High 2007 (1918-2093) 1.08 (1.03-1.13) 1250 (1166-1342) 0.72 (0.67-0.77) -1.35 (-1.56 to -1.13) <0.001 168640 (161068-176019) 91.01 (86.92- 95.02) 105002 (97759-112781) 60.47 (56.19-65.05) -1.34 (-1.56 to -1.12) <0.001 Upper-middle 5312 (4127-6468) 1.96 (1.52-2.38) 2237 (1830-2831) 0.96 (0.79-1.22) -2.36 (-2.60 to -2.11) <0.001 449233 (347823-547131) 165.74 (128.14-201.99) 187529 (153181-237547) 81.25 (66.16-103.25) -2.37 (-2.62 to -2.13) <0.001 Middle 9091 (6333-11395) 1.58 (1.10-1.98) 5250 (4001-6553) 0.92 (0.70-1.16) -1.81 (-1.99 to -1.63) <0.001 769696 (535015-966212) 133.69 (92.90-167.87) 438456 (333624-548151) 77.48 (58.79-97.13) -1.85 (-2.03 to -1.66) <0.001 Lower-middle 4036 (2722-6340) 0.85 (0.57-1.33) 4602 (3528-5889) 0.80 (0.61-1.02) -0.20 (-0.37 to -0.02) 0.639 340835 (229650-537485) 71.39 (48.13-112.15) 384614 (294364-492550) 66.73 (50.99-85.52) -0.22 (-0.39 to -0.04) 0.592 Low 1566 (926-2998) 0.66 (0.39-1.25) 3004 (1989-4071) 0.65 (0.43-0.88) -0.06 (-0.32 to 0.20) 0.027 133629 (79001-256546) 55.87 (33.01-106.25) 254615 (168184-345566) 54.88 (36.30-74.44) -0.07 (-0.32 to 0.19) 0.014 Additional Declarations No competing interests reported. Supplementary Files tableofGlobal.docx Table S1 tableofSDI.docx Table S2 Fig.S1.jpg Supply Fig 1. Global trends in age-standardized incidence rates (per 100,000 population) of brain and central nervous system cancer in children by sex, 1990-2021.(A) age-standardized incidence rate; (B) age-standardized prevalence rate; (C) age-standardized death rate; (D) age-standardized DALYs. Fig.S2.jpg Supply Fig 2. Global Burden of Disease for Cancer of the Brain and Central Nervous System in Children of Different Age Groups, 1990-2021. (A) Incidence; (B) Prevalence (C) Mortality; (D) DALYs Fig.S3.jpg Supply Fig 3. Global Burden of Disease for Childhood Cancer of the Brain and Central Nervous System in Different SDI Regions, 1990-2021. (A) age-standardized incidence rate; (B) age-standardized prevalence rate; (C) age-standardized death rate; (D) age-standardized DALYs. 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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-5814072","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":402114522,"identity":"fd513e1d-9ee5-4442-8709-a7b38740e5b0","order_by":0,"name":"Zhenjin Su","email":"","orcid":"","institution":"The First Hospital of Jilin University","correspondingAuthor":false,"prefix":"","firstName":"Zhenjin","middleName":"","lastName":"Su","suffix":""},{"id":402114523,"identity":"2a4290b5-2e6a-43aa-937c-359bd3b6d9be","order_by":1,"name":"Jie Lu","email":"","orcid":"","institution":"The First Hospital of Jilin University","correspondingAuthor":false,"prefix":"","firstName":"Jie","middleName":"","lastName":"Lu","suffix":""},{"id":402114524,"identity":"95ea2006-8d8f-44b6-925a-87b0173da119","order_by":2,"name":"Yuheng Shi","email":"","orcid":"","institution":"The First Hospital of Jilin University","correspondingAuthor":false,"prefix":"","firstName":"Yuheng","middleName":"","lastName":"Shi","suffix":""},{"id":402114525,"identity":"647f0fa6-a34d-4c27-8f54-9d8240b6a5b7","order_by":3,"name":"Tian Li","email":"","orcid":"","institution":"Tianjin Nankai Hospital, Tianjin Medical University","correspondingAuthor":false,"prefix":"","firstName":"Tian","middleName":"","lastName":"Li","suffix":""},{"id":402114526,"identity":"1e782b9f-8c02-4d7d-b7b7-3f04e8f671ec","order_by":4,"name":"Bin Qi","email":"","orcid":"","institution":"The First Hospital of Jilin University","correspondingAuthor":false,"prefix":"","firstName":"Bin","middleName":"","lastName":"Qi","suffix":""},{"id":402114528,"identity":"06a22c1f-cb1a-45e2-a2d3-dcc6048ba683","order_by":5,"name":"Zeshang Guo","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAuUlEQVRIiWNgGAWjYBAC/gYQWcEmA6IkiNIicQBEnmHjIV6LAYhgbGMgRYtE8uGPP+fx8RgcYD54m4fBLo8ILWkJxrzb2IBa2JKteRiSiwlqMbyRY5DMCNbCYybNw3AgsYGgLUAtB3/OAWnh/0a0FsMG3gawLWzEaZE48yyZmecYG4/kYTZjyzkGyYS18LcDQ+xHzTE5vuPND2+8qbAjrAUKjjEwMIPdSaR6IKghXukoGAWjYBSMPAAAB681cOBlACAAAAAASUVORK5CYII=","orcid":"","institution":"The First Hospital of Jilin University","correspondingAuthor":true,"prefix":"","firstName":"Zeshang","middleName":"","lastName":"Guo","suffix":""}],"badges":[],"createdAt":"2025-01-12 14:08:21","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5814072/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5814072/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":73900135,"identity":"cca66bf2-827b-4e92-a288-ce73bff045a1","added_by":"auto","created_at":"2025-01-15 17:09:19","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":2017454,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eGlobal trends for age-standardized rates (per 100,000 population) of childhood brain and central nervous system cancer from 1990 to 2021. \u003c/strong\u003e(A) age-standardized incidence rate; (B) age-standardized prevalence rate; (C) age-standardized death rate; (D) age-standardized DALY rate.\u003c/p\u003e","description":"","filename":"Fig.1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-5814072/v1/20bac3cb8e16d7b0a6f5e99d.jpg"},{"id":73900091,"identity":"bacbdca7-c69f-4cd0-b692-43562782b5bf","added_by":"auto","created_at":"2025-01-15 17:09:15","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":4507497,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eRegional age-standardized rates (per 100,000 population) of childhood brain and central nervous system cancer in 2021 and their percentage changes in rates for different sexes from 1990 to 2021. \u003c/strong\u003e(A) age-standardized incidence rate in 2021; (B) percentage change in age-standardized incidence rate, 1990-2021; (C) age-standardized prevalence rate in 2021; (D) percentage change in age-standardized prevalence rate, 1990-2021; (E) age-standardized Mortality in 2021; (F) percentage change in age-standardized Mortality, 1990-2021; (G) age-standardized DALYs rate in 2021; (H) percentage change in age-standardized DALYs rate, 1990-2021.\u003c/p\u003e","description":"","filename":"Fig.2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-5814072/v1/d9b183972a543c20e1b4fbb9.jpg"},{"id":73900097,"identity":"f04dd718-b18b-4c05-aebd-f1ea5c14bf8a","added_by":"auto","created_at":"2025-01-15 17:09:16","extension":"jpg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":2603552,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eTrends for age-standardized rates (per 100,000 population) of childhood Brain and central nervous system cancer among 21 regions by SDI from 1990 to 2021.\u003c/strong\u003e (A) age-standardized incidence rate; (B) age-standardized prevalence rate; (C) age-standardized death rate; (D) age-standardized DALYs rate.\u003c/p\u003e","description":"","filename":"Fig.3.jpg","url":"https://assets-eu.researchsquare.com/files/rs-5814072/v1/bdfbfe3d7a9e0ba28b2a620a.jpg"},{"id":73900098,"identity":"54109fea-d591-4f8a-b96c-7bfdaad7b343","added_by":"auto","created_at":"2025-01-15 17:09:16","extension":"jpg","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":14758865,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eCountries age-standardized rates (per 100,000 population) of childhood brain and central nervous system cancer in 2021. \u003c/strong\u003e(A) age-standardized incidence rate; (B) age-standardized prevalence rate; (C) age-standardized death rate; (D) age-standardized DALYs rate.\u003c/p\u003e","description":"","filename":"Fig.4.jpg","url":"https://assets-eu.researchsquare.com/files/rs-5814072/v1/1609ead8f82a3b0ae733b39a.jpg"},{"id":73900120,"identity":"9e672525-a467-4932-8e45-56ba879d9c96","added_by":"auto","created_at":"2025-01-15 17:09:18","extension":"jpg","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":14860621,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eTrends for age-standardized rates (per 100,000 population) of childhood Brain and central nervous system cancer in 204 countries from 1990 to 2021. \u003c/strong\u003e(A) age-standardized incidence rate; (B) age-standardized prevalence rate; (C) age- standardized death rate; (D) age-standardized DALYs rate.\u003c/p\u003e","description":"","filename":"Fig.5.jpg","url":"https://assets-eu.researchsquare.com/files/rs-5814072/v1/2d1da7284d4a7b896ff6da59.jpg"},{"id":73900124,"identity":"30272324-1fc9-46f8-b3cd-ef2e07a7a789","added_by":"auto","created_at":"2025-01-15 17:09:18","extension":"jpg","order_by":6,"title":"Figure 6","display":"","copyAsset":false,"role":"figure","size":8275059,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eTrends for age-standardized rates (per 100,000 population) of childhood Brain and central nervous system cancer among 204 countries SDI from 1990 to 2021.\u003c/strong\u003e (A) age-standardized incidence rate; (B) age-standardized prevalence rate; (C) age-standardized death rate; (D) age-standardized DALYs rate.\u003c/p\u003e","description":"","filename":"Fig.6.jpg","url":"https://assets-eu.researchsquare.com/files/rs-5814072/v1/b937073d8768429b5a409377.jpg"},{"id":73900088,"identity":"6bf35af4-bd40-4296-a8c1-08b90b86440b","added_by":"auto","created_at":"2025-01-15 17:09:15","extension":"jpg","order_by":7,"title":"Figure 7","display":"","copyAsset":false,"role":"figure","size":4091546,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003ePredict of childhood Brain and central nervous system cancer among 204 countries SDI from 1990 to 2021. \u003c/strong\u003e(A) age-standardized incidence rate; (B) age-standardized prevalence rate; (C) age-standardized death rate; (D) age-standardized DALYs rate.\u003c/p\u003e","description":"","filename":"Fig.7.jpg","url":"https://assets-eu.researchsquare.com/files/rs-5814072/v1/3b838ab17935c25d293ab289.jpg"},{"id":73900155,"identity":"9beeaf44-6dbc-475a-9a00-2b1e3d19a31c","added_by":"auto","created_at":"2025-01-15 17:09:20","extension":"jpg","order_by":8,"title":"Figure 8","display":"","copyAsset":false,"role":"figure","size":1253130,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eGraphical abstract.\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"Fig.8.jpg","url":"https://assets-eu.researchsquare.com/files/rs-5814072/v1/3c22229f5b918d4a14dd823c.jpg"},{"id":74065340,"identity":"913e00fc-ffe0-4af6-96e4-f12f128a7c8c","added_by":"auto","created_at":"2025-01-17 12:03:00","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":24813653,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5814072/v1/c9ed1ae2-2f55-402c-ae10-b94e6a261106.pdf"},{"id":73900113,"identity":"95b82bbd-9475-4117-92c1-5f7c3eea5ab1","added_by":"auto","created_at":"2025-01-15 17:09:18","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":26829,"visible":true,"origin":"","legend":"\u003cp\u003eTable S1\u003c/p\u003e","description":"","filename":"tableofGlobal.docx","url":"https://assets-eu.researchsquare.com/files/rs-5814072/v1/1c108635bb1849ec37eecad6.docx"},{"id":73900395,"identity":"a23d42c9-ed86-4a98-97b6-91c2398471a6","added_by":"auto","created_at":"2025-01-15 17:17:19","extension":"docx","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":26466,"visible":true,"origin":"","legend":"\u003cp\u003eTable S2\u003c/p\u003e","description":"","filename":"tableofSDI.docx","url":"https://assets-eu.researchsquare.com/files/rs-5814072/v1/672f2aa8481557ed2a5f37b2.docx"},{"id":73900085,"identity":"8b357c61-b417-45df-a231-1992c1a3f2d0","added_by":"auto","created_at":"2025-01-15 17:09:14","extension":"jpg","order_by":3,"title":"","display":"","copyAsset":false,"role":"supplement","size":4127454,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eSupply Fig 1. Global trends in age-standardized incidence rates (per 100,000 population) of brain and central nervous system cancer in children by sex, 1990-2021.\u003c/strong\u003e(A) age-standardized incidence rate; (B) age-standardized prevalence rate; (C) age-standardized death rate; (D) age-standardized DALYs.\u003c/p\u003e","description":"","filename":"Fig.S1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-5814072/v1/737bac07f02de2d44f26d554.jpg"},{"id":73900115,"identity":"79e15471-7943-4608-a868-75785e98439d","added_by":"auto","created_at":"2025-01-15 17:09:18","extension":"jpg","order_by":4,"title":"","display":"","copyAsset":false,"role":"supplement","size":8545055,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eSupply Fig 2.\u003c/strong\u003e \u003cstrong\u003eGlobal Burden of Disease for Cancer of the Brain and Central Nervous System in Children of Different Age Groups, 1990-2021.\u003c/strong\u003e (A) Incidence; (B) Prevalence (C) Mortality; (D) DALYs\u003c/p\u003e","description":"","filename":"Fig.S2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-5814072/v1/6d4bb46c71c8d21e7253fe77.jpg"},{"id":73901121,"identity":"8758a614-c1e1-4732-bbc3-3e770aec4d59","added_by":"auto","created_at":"2025-01-15 17:25:18","extension":"jpg","order_by":5,"title":"","display":"","copyAsset":false,"role":"supplement","size":8300267,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eSupply Fig 3.\u003c/strong\u003e \u003cstrong\u003eGlobal Burden of Disease for Childhood Cancer of the Brain and Central Nervous System in Different SDI Regions, 1990-2021.\u003c/strong\u003e (A) age-standardized incidence rate; (B) age-standardized prevalence rate; (C) age-standardized death rate; (D) age-standardized DALYs.\u003c/p\u003e","description":"","filename":"Fig.S3.jpg","url":"https://assets-eu.researchsquare.com/files/rs-5814072/v1/82305e8794d5e0d29f7f7c10.jpg"}],"financialInterests":"No competing interests reported.","formattedTitle":"Global, regional, and national childhood brain and central nervous system cancer burden: An analysis based on the Global Burden of Disease Study","fulltext":[{"header":"1. Introduction","content":"\u003cp\u003eChildhood brain and central nervous system (CNS) cancers are the most common solid tumors in children and the leading cause of childhood mortality, particularly in developed countries\u003csup\u003e\u003cspan additionalcitationids=\"CR2 CR3\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e. These cancers are often diagnosed late and are associated with a poor prognosis\u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e,\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eBrain and CNS cancers encompass tumors of the brain and spinal cord, with brain tumors constituting over 90% of cases\u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e. Research indicates that the incidence of these cancers in children decreases with age, with the highest incidence occurring in the 0\u0026ndash;4 year age group\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e,\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e,\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e. Malignant tumors constitute approximately 30% of childhood brain and CNS cancers. Gliomas and germ cell tumors are more common in boys, whereas pituitary tumors and meningiomas are more prevalent in girls\u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e. Brain and CNS cancers typically present with nonspecific symptoms, such as headaches and dizziness. In children, these symptoms often manifest as poor learning and fatigue. The nonspecific nature of these symptoms often leads to the disease being overlooked\u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e. Despite recent improvements in prognosis due to advances in medical science, updated therapeutic guidelines, and targeted molecular therapies, childhood brain and CNS cancers continue to represent a substantial global health challenge\u003csup\u003e\u003cspan additionalcitationids=\"CR12 CR13 CR14\" citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eTherefore, it is crucial to assess the specific burden of childhood brain and CNS cancers to inform efforts to mitigate this global health issue. The Global Burden of Disease Study (GBD) 2021 (the latest year) provides four key metrics to assess the burden, covering data from 204 countries and territories across various regions\u003csup\u003e\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u003c/sup\u003e. Using the latest GBD 2021 data, we analyzed the burden and trends of childhood brain and CNS cancers at the global, regional, national, and local levels from 1990 to 2021.\u003c/p\u003e"},{"header":"2. Method","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e2.1 Study population\u003c/h2\u003e \u003cp\u003eBrain and CNS cancer data, as defined by the GBD project, were collected for both sexes across three age categories (\u0026lt;\u0026thinsp;5 years, 5\u0026ndash;9 years, 10\u0026ndash;14 years) and from 204 national and regional subcategories. We categorized children as 0\u0026ndash;14 years old and divided them into three age subcategories: \u0026lt;5 years, 5\u0026ndash;9 years, and 10\u0026ndash;14 years, to better analyze age-related differences. All countries and territories were categorized into 21 regions based on epidemiological similarities and geographical proximity.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003e2.2 Data collection\u003c/h2\u003e \u003cp\u003eWe analyzed data from the Global Burden of Disease (GBD) Study 2021 (\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://ghdx.healthdata.org/gbd-2021/sources\u003c/span\u003e\u003cspan address=\"https://ghdx.healthdata.org/gbd-2021/sources\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e). This dataset encompasses information on 369 diseases and injuries, including brain and CNS cancer, across 204 countries and territories from 1990 to 2021. In this study, we extracted data on the incidence, prevalence, mortality and DALYs of the brain and central nervous system cancers in individuals aged 0\u0026ndash;14 years from the GBD 2021 through the GBD Results Tool (\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://vizhub.healthdata.org/gbdresults/\u003c/span\u003e\u003cspan address=\"https://vizhub.healthdata.org/gbdresults/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIncident cases, prevalent cases, deaths, disability-adjusted life years (DALYs), incidence, and prevalence rates were extracted directly from GBD 2021, with all rates reported per 100,000 population. The 95% uncertainty interval (UI) was determined by the 25th and 95th percentiles of the 1,000 estimates generated by the GBD algorithm.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003e2.3 Sociodemographic index\u003c/h2\u003e \u003cp\u003eGBD 2021 also provided the Social Demographic Index (SDI) for each country, a composite measure reflecting social and economic conditions that influencing health outcomes. The SDI is calculated as the geometric mean of three indices (scaled from 0 to 1): total fertility rate among individuals under 25, average years of education for individuals aged 15 and older, and lag-distributed income per capita. An SDI of 0 indicates minimal education, low per capita income, and high fertility rates. The SDI is divided into five quintiles: low, lower-middle, middle, upper-middle, and high regions.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003e2.4 Statistical analysis\u003c/h2\u003e \u003cp\u003eWe calculated age-standardized rates (ASRs) per 100,000 people of brain and CNS cancer from 0 to 14 years, according to the formula:\u003cdiv id=\"Equa\" class=\"Equation\"\u003e\u003cdiv format=\"TEX\" class=\"mathdisplay\" id=\"FileID_Equa\" name=\"EquationSource\"\u003e\n$$\\:\\frac{{\\varSigma\\:}_{i=1}^{N}{\\alpha\\:}_{i}{W}_{i}}{{\\varSigma\\:}_{i=1}^{N}{W}_{i}}$$\u003c/div\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eIn the equation, \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:{\\alpha\\:}_{i}\\)\u003c/span\u003e\u003c/span\u003e represents the age-specific rate in the \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:i\\)\u003c/span\u003e\u003c/span\u003eth age group, while \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:{W}_{i}\\)\u003c/span\u003e\u003c/span\u003e denotes the count of individuals within the same age group based on the GBD 2021 standard population.\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:N\\)\u003c/span\u003e\u003c/span\u003e is the total of age categories.\u003c/p\u003e \u003cp\u003eThe primary objective of this study was to analyze global trends in the incidence, prevalence, mortality, and DALYs associated with childhood brain and CNS cancer. We computed the average annual percentage change (AAPC) for these metrics across the 0\u0026ndash;14 age group and its three subcategories using linear regression models. The AAPC summarizes trends over a specified interval, computed as a weighted average of annual percentage change (APC), allowing a single value to represent the average trend over multiple years. AAPC was determined using the geometrical weighted average of APCs. The AAPC value represents the annual rate of variation; for example, an AAPC of 0.5 indicates an yearly increase of 0.5%.\u003c/p\u003e \u003cp\u003eThe second aim was to determine periods with significant changes in the incidence, prevalence, mortality, and DALYs trends for childhood brain and CNS cancer. To fulfill this goal, we applied Joinpoint Regression Analysis to detect temporal changes and fit the most parsimonious model by connecting separate line segments on a logarithmic scale. These portions known as joinpoints mark changes in trend. The final model based on professional judgment and the Weighted Bayesian Information Criterion within the Joinpoint software. We then examined trends in incidence, prevalence, mortality, and DALYs by age, sex, five SDI regions, 21 GBD regions, and 204 countries. Tendencies were plotted by SDI index across the 21 GBD regions and 204 countries. Finally, we projected the incidence, prevalence, mortality, and DALYs of childhood brain and CNS cancer for 2030 projections were made using the Bayesian age-period-cohort model.\u003c/p\u003e \u003cp\u003eAll statistical analyses were performed using RStudio (version 2024.4.2.0) and the Joinpoint Regression Program (version 4.9.1.0).\u003c/p\u003e \u003c/div\u003e"},{"header":"3. Result","content":"\u003cp\u003e\u003cstrong\u003e3.1 Age-standardized global Trends\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eGlobally, the incidence of childhood brain and CNS cancer exhibited a general decline from 1990 to 2021 (AAPC = -0.52, 95% CI [-0.62, -0.42]). Joinpoint regression analysis recognized marked shifts in incidence rates during 1997, 2005, and 2019. The incidence rate experienced a slight decline from 1990-1997 (AAPC = -0.02, 95% UI [-0.22, 0.17]), a marked decline between 1998-2005 (AAPC = -1.56, 95% UI [-1.72, -1.39]), an increase from 2006-2019 (AAPC = 0.43, 95% UI [0.37, 0.49]), and a significant decline after 2020 (AAPC = -4.67, 95% UI [-5.90, -3.41]). Joinpoint regression also recognized marked shifts in the disease prevalence in 2000, 2004, and 2019. While there was a decline in prevalence between 2000-2004 and post-2019 (AAPC = -1.17, 95% UI [-1.89, -0.44]; AAPC = -4.96, 95% UI [-6.61, -3.29]), the overall trend from 1990 to 2021 showed a uptick (AAPC = 0.27, 95% CI [0.12, 0.42]). As shown in Fig.1 and Table 1-2.\u003c/p\u003e\n\u003cp\u003eFrom 1990 to 2021, both the mortality and DALYs for the disease dispalyed a consistent decline (AAPC = -1.44, 95% UI [-1.57, -1.31]; AAPC = -1.46, 95% CI [-1.59, -1.33]). Joinpoint regression analysis showed significant changes in mortality rates and DALYs during 1997, 2006, and 2018. As shown in Fig.1 and Table 1-2.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.2 Age-standardized global trends by sex\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eGlobally, the incidence of brain and CNS cancer has been declining in both boys and girls. Incidence rates dropped from 2.03 per 100,000 (95% UI [1.28, 2.87]) and 1.76 per 100,000 (95% UI [1.21, 2.58]) to 1.67 per 100,000 (95% UI [1.13, 2.27]) in boys, and from 1.63 per 100,000 (95% UI [1.35, 1.91]) in girls. The AAPC was -0.68 (95% CI [-0.82, -0.53]) for boys and -0.32 (95% CI [-0.42, -0.22]) for girls. Although exhibited a higher incidence in boys than in girls, the gap between the sexes is gradually narrowing. From 1990 to 2021, there was an upward trend in the prevalence of the disease in both boys and girls. Prevalence increased from 7.58 per 100,000 (95% UI [5.09, 10.38]) in boys and 6.96 per 100,000 (95% UI [5.02, 9.67]) in girls in 1990, to 8.17 per 100,000 (95% UI [5.56, 11.00]) in boys and 8.09 per 100,000 (95% UI [6.61, 9.55]) in girls by 2021. The AAPC for prevalence was 0.19 (95% CI [0.02, 0.35]) for boys and 0.38 (95% CI [0.25, 0.52]) for girls. As shown in Fig.S1 and Table 1-2.\u003c/p\u003e\n\u003cp\u003eMortality rates and DALYs followed similar trends in both boys and girls, with a consistent decline. The AAPC for mortality was -1.66 (95% CI [-1.82, -1.49]) for boys and -1.22 (95% CI [-1.33, -1.13]) for girls. The AAPC regarding DALYs was -1.68 (95% CI [-1.84, -1.51]) for boys and -1.24 (95% CI [-1.36, -1.13]) for girls. As shown in Table 1-2.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.3 Global trends by age group\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eGlobally, the incidence of brain and CNS cancer in children between the age of 10 and 14 years exhibited a rising trend from 1990 to 2021, growing from 1.36 per 100,000 (95% UI [1.10, 1.59]) in 1990 to 1.49 per 100,000 (95% UI [1.27, 1.80]) in 2021. The AAPC for this group was 0.29 (95% CI [0.14, 0.45]). In the other two age categories, the incidence exhibited a declining trend, with the most notable decrease observed in children under 5 years old, dropping from 2.47 per 100,000 (95% UI [1.81, 3.25]) in 1990 to 1.77 per 100,000 (95% UI [1.36, 2.25]) in 2021.The AAPC value was -1.2, (95% CI [-1.32, -1.07]). In the 5-9 year age group, the AAPC was -0.26 (95% CI [-0.45, -0.06]). As shown in Fig.S2 and Table 1-2.\u003c/p\u003e\n\u003cp\u003eMortality and DALYs trends were uniform across all three age categories, showing a declining trend. The most significant reduction in mortality occurred in children under 5 years, decreasing from 1.62 per 100,000 (95% UI [1.14, 2.18]) in 1990 to 0.86 per 100,000 (95% UI [0.64, 1.13]) in 2021, with an AAPC of -2.12 (95% CI [-2.26, -1.98]). The AAPC values for the 5-9 and 10-14 year age categories were -1.23 (95% CI [-1.38, -1.08]) and -0.65 (95% CI [-0.77, -0.53]), respectively. Similarly, the most marked reduction in DALYs was found in children under 5 years old. DALYs decreased from 143.38 (95% UI [101.31, 193.18]) in 1990 to 76.36 (95% UI [57.26, 99.81]) in 2021, with an AAPC of -2.11 (95% CI [-2.25, -1.97]). The AAPC values for the 5-9 and 10-14 year age categories were -1.22 (95% CI [-1.38, -1.07]) and -0.64 (95% CI [-0.76, -0.52]). As shown in Fig.S2 and Table 1-2.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.4 Age-standardized global trends by SDI region\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe divided the globe into five regions on the basis of the SDI and compared childhood brain and CNS cancer incidence, mortality, and DALYs across these regions.\u003c/p\u003e\n\u003cp\u003eThe incidence of childhood brain and CNS cancer was more prevalent in the high and upper-middle SDI regions, while the low SDI region had the lowest incidence. Overall, incidence rates declined in all regions excluding the low and lower-middle SDI regions. The most notable decrease existed in the middle SDI region, where the incidence rate fell from 2.22 per 100,000 (95% UI [1.56, 2.76]) in 1990 to 1.99 per 100,000 (95% UI [1.51, 2.53]) in 2021, with an AAPC of -0.46 (95% CI [-0.68, -0.25]). In the upper-middle SDI region, the AAPC was -0.43 (95% CI [-0.70, -0.16]), while the high SDI region experienced only a mild reduction, with an AAPC of -0.09 (95% CI [-0.29, 0.10]). Notably, the incidence in the high SDI region surpassed that in the upper-middle SDI region for the first time in 2012. Regarding prevalence, the high SDI region consistently had the highest rates. Prevalence increased across all regions, with the most notable rise in the upper-middle SDI region, where it grew from 11.62 per 100,000 (95% UI [9.09, 14.11]) in 1990 to 16.34 per 100,000 (95% UI [12.74, 21.40]) in 2021, with an AAPC of 0.97 (95% CI [0.62, 1.32]). As shown in Fig.S3 and Table 3-4.\u003c/p\u003e\n\u003cp\u003eMortality rates and DALYs both showed significant declines, particularly in the upper-middle SDI region. Mortality rates diminish from 1.96 per 100,000 (95% UI [1.52, 2.38]) in 1990 to 0.96 per 100,000 (95% UI [0.79, 1.22]) in 2021, with an AAPC of -2.36 (95% CI [-2.60, -2.11]). DALYs decreased from 165.74 (95% UI [128.14, 201.99]) to 81.25 (95% UI [66.16, 103.25]), with an AAPC of -2.37 (95% CI [-2.62, -2.13]). As shown in Fig.S3 and Table 3-4.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.5 Regional age-standardized burden of childhood brain and CNS cancer\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn 2021, East Asia had the greatest ASIR of childhood brain and CNS cancer, followed by High Income Asia Pacific. The greatest ASPR was noted in High Income Asia Pacific, with High Income North America ranking second. Central Asia had the highest ASMR and DALYs, followed by Andean Latin America. Since 1990, ASIRs have risen in over half of the regions, the most notable rise in Southern Sub-Saharan Africa. Prevalence rates have also increased in most regions, especially in North Africa and the Middle East. Mortality rates and DALYs have decreased in most regions, with the most significant reduction occurring in East Asia. Additionally, ASIR, ASPR, age-standardized rate of Mortality\u003c/p\u003e\n\u003cp\u003eASMR, and DALYs are generally higher for boys compared to girls in most regions, consistent with global trends. As shown in Fig.2.\u003c/p\u003e\n\u003cp\u003eThe burden of childhood brain and CNS cancer varies significantly by SDI. Higher SDI regions tend to have higher ASIR and ASPR. While ASIR and ASPR generally increase with higher SDI, regional patterns show considerable variation. Some regions exhibit declining ASIR and ASPR with rising SDI, while other indexes show increasing rates or no clear trend. Conversely, age-standardized death rates and DALYs consistently decrease with higher SDI, with higher SDI areas experiencing lower ASMR and DALYs. As shown in Fig.3.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.6 National age-standardized trends\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn 2021, Monaco had the greatest ASIR of childhood brain and CNS cancer globally, with an incidence of 8.18 per 100,000 (95% UI [4.45, 13.41]). Conversely, Gambia had the least incidence at 0.15 per 100,000 (95% UI [0.07, 0.25]). Monaco also recorded the greatest ASPR at 58.25 per 100,000 (95% UI [31.61, 196.25]), while Gambia had the least prevalence rate of 0.49 per 100,000 (95% UI [0.22, 0.82]). As shown in Fig.4.\u003c/p\u003e\n\u003cp\u003eFor mortality rates and DALYs in 2021, Tajikistan reported the highest rates globally, with 2.93 per 100,000 (95% UI [1.46, 4.57]) for mortality and 249.10 (95% UI [123.31, 387.88]) for DALYs. In contrast, Cook Islands had the least rates, with 0.11 per 100,000 (95% UI [0.06, 0.18]) for mortality and 8.98 (95% UI [4.79, 15.32]) for DALYs. As shown in Fig.4.\u003c/p\u003e\n\u003cp\u003eBetween 1990 and 2021, Greenland saw the greatest decline in ASIR, with an AAPC of -2.04 (95% CI [-2.38, -1.70]). Luxembourg saw the greatest decrease in ASPR, with an AAPC of -2.41 (95% CI [-4.74, -0.02]). Luxembourg also had the largest reduction in ASMR, with an AAPC of -3.22 (95% CI [-3.95, -2.48]). Serbia experienced the greatest notable decline in DALYs, with an AAPC of -3.17 (95% CI [-3.69, -2.64]). As shown in Fig.5.\u003c/p\u003e\n\u003cp\u003eThe burden of childhood brain and CNS cancer varies significantly based on SDI. ASIR and ASPR increase with higher SDI values, showing a clear upward trend. However, ASMR and DALYs are highest in regions with SDI values between 0.625 and 0.75. As shown in Fig.6.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.7 Forecasting trends in childhood brain and CNS cancer\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFigure 7 presents our forecast for future trends in childhood brain and CNS cancer. Our projections indicate a continued decline in all key metrics: incidence, prevalence, mortality, and DALYs. Specifically, ASIR is expected to decrease from 1.65 per 100,000 in 2021 to 1.24 per 100,000 by 2030. ASPR is projected to fall from 8.13 per 100,000 in 2021 to 5.91 per 100,000 in 2030. Similarly, the mortality rate is anticipated to drop from 0.82 per 100,000 in 2021 to 0.59 per 100,000 in 2030. DALYs are forecasted to decrease from 68.54 in 2021 to 50.15 in 2030.\u003c/p\u003e"},{"header":"4. Discussion","content":"\u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003e4.1 Main interpretation\u003c/h2\u003e \u003cp\u003eChildhood brain and CNS cancer is the most prevalent solid tumor in children aged 0\u0026ndash;14 years\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e, with incidence rates decreasing as children age and being higher in boys compared to girls. The standard treatment for childhood gliomas typically involves complete surgical resection followed by radiotherapy, provided it is feasible.\u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e. However, the complexities of intracranial surgery, along with the risks associated with cranial radiation and the toxicity of chemotherapeutic agents, can significantly impact children's brain development\u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e,\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u003c/sup\u003e. These challenges contribute to the relatively rare occurrence of childhood brain and CNS cancer, which remains among the three most prominent causes of childhood mortality. Consequently, it poses a substantial global health burden\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e,\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e,\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eThe latest GBD study indicates that in 2021, there will be 33,091 new cases of childhood brain and CNS cancer and 16,356 deaths worldwide. At present, there are 162,900 individuals with brain and CNS cancer and 1,371,300 DALYs.\u003csup\u003e\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u003c/sup\u003e. While the overall incidence of childhood brain and CNS cancer has been decreasing, there was a noticeable rebound between 2005 and 2019, as also observed by Miller et al.\u003csup\u003e\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e This rebound may be attributed to the adoption of molecular diagnostic techniques, advancements in diagnostic methods, and improvements in disease registry follow-up.\u003csup\u003e\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e,\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e,\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u003c/sup\u003e. Previous research indicates that brain and CNS cancer is most common in children aged 0 to 4 years, with the highest mortality rates occurring within the first year of life.\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e,\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e,\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e. Recent advancements in prenatal diagnostic techniques and screening for tumor-susceptible syndromes have likely contributed to a decline in the incidence of this disease\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e,\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u003c/sup\u003e. In line with earlier studies, our findings show a consistent decline in global mortality and DALYs for childhood brain and CNS cancers from 1990 to 2021\u003csup\u003e3\u003c/sup\u003e This trend can be attributed to the standardization of treatment protocols, improved grading of treatment intensity, and advancements in therapies such as tumor vaccines and lysoviruses\u003csup\u003e\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e,\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u003c/sup\u003e. Our analysis of data from 1990 to 2021 reveals a notable acceleration in the rate of decline in incidence and mortality after 2018. This improvement is likely linked to the updated WHO classification of CNS cancers, as well as advancements in technologies such as fluorescence lifetime imaging microscopy, pediatric cancer model atlases, and proton therapy \u003csup\u003e\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e,\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e,\u003cspan additionalcitationids=\"CR24 CR25 CR26\" citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e\u003c/sup\u003e. Our projections suggest that the incidence, mortality, and DALYs of this disease will continue to decrease in the future.\u003c/p\u003e \u003cp\u003eSignificant differences were observed within the five SDI regions, with high and upper-high SDI areas reporting higher rates of incidence, survival, mortality, and DALYs for childhood brain and CNS cancers compared to other regions. Previous research supports the link between childhood brain and CNS cancer incidence and economic development levels \u003csup\u003e\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e\u003c/sup\u003e, with ionizing radiation being the only identified risk factor for these cancers \u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e,\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e\u003c/sup\u003e, High and middle-high SDI regions are exposed to higher levels of ionizing radiation\u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e. Additionally, harmful substances such as carbon monoxide, butadiene and diesel vehicle emissions may also contribute to increased cancer rates\u003csup\u003e\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e\u003c/sup\u003e. Moreover, these areas benefit from more advanced healthcare systems and better screening tools, which further influence cancer incidence. While ASMR and DALYs are decreasing across all SDI regions, the lower availability of medical resources in lower-middle and low SDI regions leads to a slower decline in these metrics \u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e,\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eAmong the 204 countries and regions analyzed, Africa shows relatively low rates of incidence and high rates of mortality for childhood brain and CNS cancers. This is likely due to the continent's lower socio-economic status\u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e. Additionally, research indicates that black children have a lower incidence of brain and CNS cancers as opposed to white children, possibly due to inter-ethnic epigenetic differences\u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e,\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e\u003c/sup\u003e. Underdiagnosis also contributes to the lower reported prevalence in Africa, with some studies showing that up to 50% of cases in low-income areas are underdiagnosed\u003csup\u003e\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e\u003c/sup\u003e. Furthermore, black children with brain and CNS cancers generally experience higher mortality rates than white children, which helps explain the elevated mortality rates observed in Western Asian countries.\u003csup\u003e\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eUnlike previous studies on childhood tumors, our research specifically examines brain and CNS cancers, incorporating the most recent data from 2020 and 2021. While we have made significant efforts to provide a thorough analysis, our study relies on secondary data from the GBD.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003e4.2 Limitation\u003c/h2\u003e \u003cp\u003elimitations in cancer registry systems in some regions may introduce bias, so our findings should be interpreted with caution. This study is dependent on secondary analysis based on existing database data, and the accuracy is to some extent dependent on the accuracy of the original data.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003e4.3 conclusion\u003c/h2\u003e \u003cp\u003eThis study offers a comprehensive view of the global burden of childhood brain and CNS cancers from various angles. Despite progress in medical science and technology leading to a reduction in disease burden, substantial human, material, and financial resources remain necessary to address this issue annually. We hope this research will provide policymakers and encourage the effective allocation of global resources to further mitigate the impact of this disease.\u003c/p\u003e \u003c/div\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eBrain and CNS cancer\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eBrain and central nervous system cancer\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eDALYs\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eDisability-adjusted life years\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eUI\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eUncertainty interval\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eSDI\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eSocio-demographic index\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eGBD\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eThe Global Burden of Disease Study\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eAAPC\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eAverage annual percentage change\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eAPC\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eAnnual percentage change\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eASIR\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eAge-standardized incidence rate\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eASPR\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eAge-standardized prevalence rate\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eASMR\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eAge-standardized rate of Mortality\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAuthorship contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eZJ Su developed the concept and authored the main body of the article. Jie Lu conducted the data collection and analysis. YH Shi is responsible for visualizing data. ZS Guo, T Li and Bin Qi proofread, reviewed, and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNone.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll data used in this study can be find at the GBD 2021 study (https://vizhub.healthdata.org/gbd-results). In the meantime, we have uploaded the data used in this article to the supplementary material.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData used for the analysis can be find at the Institute of Health Metrics and Evaluation (http://www.healthdata.org/; http://ghdx.healthdata.org/gbd-results-tool). We sincerely thank all the members of the Global Burden of Disease 2021 Collaborative Group for their commitment. Based on their work, we have analyzed and deepened our understanding of the burden of disease.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study passed the review of the Ethics Committee of the First Hospital of Jilin University (2024-328) and GBD website.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe author(s) declare no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDeclaration of generative AI-assisted technologies in the writing process\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDuring the preparation of this work the authors used ChatGPT 4.0 to Check manuscripts for grammatical errors and improve the coherence and readability of the manuscript (excluding writing draft of manuscript, paragraph, or sentences, only for language polishing purpose).\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eLegler JM, et al. brain and other central nervous system cancers recent trends in incidence and mortality. 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Lancet Oncol. 2020;21:e185\u0026ndash;224. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/s1470-2045(20)30022-x\u003c/span\u003e\u003cspan address=\"10.1016/s1470-2045(20)30022-x\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003e\u003cstrong\u003eTable 1.Global burden of childhood cancer in 2021 and its AAPC from 1990 to 2021\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"996\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 89px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"6\" valign=\"top\" style=\"width: 456px;\"\u003e\n \u003cp\u003eIncidence\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"6\" valign=\"top\" style=\"width: 450px;\"\u003e\n \u003cp\u003ePrevalence\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 89px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003eCases (n), 1990\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003eIncidence\u003c/p\u003e\n \u003cp\u003e(per 100 000 population), 1990\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003eCases (n), 2021\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003eIncidence\u003c/p\u003e\n \u003cp\u003e(per 100 000 population), 2021\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003eAAPC,\u003c/p\u003e\n \u003cp\u003e1990-2021\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003ep value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003eCases (n), 1990\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003ePrevalence\u003c/p\u003e\n \u003cp\u003e(per 100 000 population), 1990\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003eCases (n), 2021\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003ePrevalence\u003c/p\u003e\n \u003cp\u003e(per 100 000 population), 2021\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003eAAPC,\u003c/p\u003e\n \u003cp\u003e1990-2021\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003ep value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 89px;\"\u003e\n \u003cp\u003eGlobal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e33107\u003c/p\u003e\n \u003cp\u003e(25238-41603)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e1.90\u003c/p\u003e\n \u003cp\u003e(1.45-2.38)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e33091\u003c/p\u003e\n \u003cp\u003e(26727-40701)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e1.65\u003c/p\u003e\n \u003cp\u003e(1.33-2.03)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e-0.52\u003c/p\u003e\n \u003cp\u003e(-0.62 to -0.42)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e127138\u003c/p\u003e\n \u003cp\u003e(99975-155213)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e7.28\u003c/p\u003e\n \u003cp\u003e(5.73-8.88)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e162879\u003c/p\u003e\n \u003cp\u003e(133143-199896)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e8.13\u003c/p\u003e\n \u003cp\u003e(6.63-9.99)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e0.27\u003c/p\u003e\n \u003cp\u003e(0.12 to 0.42)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"13\" valign=\"top\" style=\"width: 996px;\"\u003e\n \u003cp\u003esex\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 89px;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e18166\u003c/p\u003e\n \u003cp\u003e(11497-25766)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e2.03\u003c/p\u003e\n \u003cp\u003e(1.28-2.87)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e17255\u003c/p\u003e\n \u003cp\u003e(11733-23502)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e1.67\u003c/p\u003e\n \u003cp\u003e(1.13-2.27)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e-0.68\u003c/p\u003e\n \u003cp\u003e(-0.82 to -0.53)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e68068\u003c/p\u003e\n \u003cp\u003e(45563-99223)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e7.58\u003c/p\u003e\n \u003cp\u003e(5.09-10.38)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e84536\u003c/p\u003e\n \u003cp\u003e(57733-113772)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e8.17\u003c/p\u003e\n \u003cp\u003e(5.56-11.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e0.19\u003c/p\u003e\n \u003cp\u003e(0.02 to 0.35)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e0.026\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 89px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e14942\u003c/p\u003e\n \u003cp\u003e(10289-21897)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e1.76\u003c/p\u003e\n \u003cp\u003e(1.21-2.58)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e15836\u003c/p\u003e\n \u003cp\u003e(13158-18474)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e1.63\u003c/p\u003e\n \u003cp\u003e(1.35-1.91)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e-0.32\u003c/p\u003e\n \u003cp\u003e(-0.42 to -0.22)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e59070\u003c/p\u003e\n \u003cp\u003e(42573-82199)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e6.96\u003c/p\u003e\n \u003cp\u003e(5.02-9.67)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e78343\u003c/p\u003e\n \u003cp\u003e(64131-92352)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e8.09\u003c/p\u003e\n \u003cp\u003e(6.61-9.55)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e0.38\u003c/p\u003e\n \u003cp\u003e(0.25 to 0.52)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"13\" valign=\"top\" style=\"width: 996px;\"\u003e\n \u003cp\u003eAge group, years\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 89px;\"\u003e\n \u003cp\u003e0-4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e15340\u003c/p\u003e\n \u003cp\u003e(11231-20140)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e2.47\u003c/p\u003e\n \u003cp\u003e(1.81-3.25)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e11617\u003c/p\u003e\n \u003cp\u003e(8947-14807)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e1.77\u003c/p\u003e\n \u003cp\u003e(1.36-2.25)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e-1.2\u003c/p\u003e\n \u003cp\u003e(-1.32 to -1.07)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e61472\u003c/p\u003e\n \u003cp\u003e(46312-78413)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e9.92\u003c/p\u003e\n \u003cp\u003e(7.47-12.65)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e59475\u003c/p\u003e\n \u003cp\u003e(46057-75035)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e9.04\u003c/p\u003e\n \u003cp\u003e(7.00-11.40)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e-0.42\u003c/p\u003e\n \u003cp\u003e(-0.67 to -0.17)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 89px;\"\u003e\n \u003cp\u003e5-9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e10464\u003c/p\u003e\n \u003cp\u003e(8138-12932)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e1.79\u003c/p\u003e\n \u003cp\u003e(1.39-2.22)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e11509\u003c/p\u003e\n \u003cp\u003e(9336-13927)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e1.68\u003c/p\u003e\n \u003cp\u003e(1.36-2.03)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e-0.26\u003c/p\u003e\n \u003cp\u003e(-0.45 to -0.06)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e0.009\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e37752\u003c/p\u003e\n \u003cp\u003e(30360-45216)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e6.47\u003c/p\u003e\n \u003cp\u003e(5.20-7.75)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e53661\u003c/p\u003e\n \u003cp\u003e(44498-64794)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e7.81\u003c/p\u003e\n \u003cp\u003e(6.48-9.43)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e0.58\u003c/p\u003e\n \u003cp\u003e(0.34 to 0.81)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 89px;\"\u003e\n \u003cp\u003e10-14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e7304\u003c/p\u003e\n \u003cp\u003e(5869-8531)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e1.36\u003c/p\u003e\n \u003cp\u003e(1.10-1.59)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e9965\u003c/p\u003e\n \u003cp\u003e(8444-11967)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e1.49\u003c/p\u003e\n \u003cp\u003e(1.27-1.80)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e0.29\u003c/p\u003e\n \u003cp\u003e(0.14 to 0.45)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e27915\u003c/p\u003e\n \u003cp\u003e(23302-31584)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e5.21\u003c/p\u003e\n \u003cp\u003e(4.35-5.89)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e49743\u003c/p\u003e\n \u003cp\u003e(42589-60067)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e7.46\u003c/p\u003e\n \u003cp\u003e(6.39-9.01)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e1.17\u003c/p\u003e\n \u003cp\u003e(1.00to 1.35)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable 2. The mortality and DALYs of childhood cancer in 2021 and its AAPC from 1990 to 2021.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"996\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003eMortality\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003eDAYLs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\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: 88px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003eCases (n), 1990\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003eMortality\u003c/p\u003e\n \u003cp\u003e(per 100 000 population), 2019\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003eCases (n), 2021\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003eMortality\u003c/p\u003e\n \u003cp\u003e(per 100 000 population), 2021\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003eAAPC,\u003c/p\u003e\n \u003cp\u003e1990-2021\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003ep value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003eCases (n), 1990\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003eDAYLs\u003c/p\u003e\n \u003cp\u003e(per 100 000 population), 1990\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003eCases (n), 2021\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003eDAYLs\u003c/p\u003e\n \u003cp\u003e(per 100 000 population), 2021\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003eAAPC,\u003c/p\u003e\n \u003cp\u003e1990-2021\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003ep value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003eGlobal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e22031\u003c/p\u003e\n \u003cp\u003e(16236-28461)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e1.26\u003c/p\u003e\n \u003cp\u003e(0.93-1.63)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e16356\u003c/p\u003e\n \u003cp\u003e(12828-20343)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e0.82\u003c/p\u003e\n \u003cp\u003e(0.64-1.02)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e-1.44\u003c/p\u003e\n \u003cp\u003e(-1.57 to -1.31)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e1863538\u003c/p\u003e\n \u003cp\u003e(1370838-2410914)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e107.15\u003c/p\u003e\n \u003cp\u003e(78.82-138.63)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e1371309\u003c/p\u003e\n \u003cp\u003e(1074065-1706987)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e68.54\u003c/p\u003e\n \u003cp\u003e(53.58-85.48)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e-1.46\u003c/p\u003e\n \u003cp\u003e(-1.59 to -1.33)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"13\" valign=\"top\" style=\"width: 996px;\"\u003e\n \u003cp\u003esex\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e12539\u003c/p\u003e\n \u003cp\u003e(7545-18421)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e1.40\u003c/p\u003e\n \u003cp\u003e(0.84-2.04)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e8778\u003c/p\u003e\n \u003cp\u003e(5979-12030)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e0.85\u003c/p\u003e\n \u003cp\u003e(0.58-1.16)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e-1.66\u003c/p\u003e\n \u003cp\u003e(-1.82 to -1.49)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e1059678\u003c/p\u003e\n \u003cp\u003e(635296-1561078)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e118.05\u003c/p\u003e\n \u003cp\u003e(70.88-173.68)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e735204\u003c/p\u003e\n \u003cp\u003e(499629-1007972)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e71.13\u003c/p\u003e\n \u003cp\u003e(48.20-97.64)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e-1.68\u003c/p\u003e\n \u003cp\u003e(-1.84 to -1.51)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e9492\u003c/p\u003e\n \u003cp\u003e(6226-14929)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e1.12\u003c/p\u003e\n \u003cp\u003e(0.74-1.77)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e7578\u003c/p\u003e\n \u003cp\u003e(6242-8819)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e0.78\u003c/p\u003e\n \u003cp\u003e(0.64-0.91)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e-1.22\u003c/p\u003e\n \u003cp\u003e(-1.33 to -1.13)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e803860\u003c/p\u003e\n \u003cp\u003e(525064-1271695)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e94.72\u003c/p\u003e\n \u003cp\u003e(61.94-149.60)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e636106\u003c/p\u003e\n \u003cp\u003e(523007-741090)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e65.77\u003c/p\u003e\n \u003cp\u003e(53.98-76.75)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e-1.24\u003c/p\u003e\n \u003cp\u003e(-1.36 to -1.13)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"13\" valign=\"top\" style=\"width: 996px;\"\u003e\n \u003cp\u003eAge group, years\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e0-4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e10040\u003c/p\u003e\n \u003cp\u003e(7089-13544)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e1.62\u003c/p\u003e\n \u003cp\u003e(1.14-2.18)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e5660\u003c/p\u003e\n \u003cp\u003e(4242-7405)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e0.86\u003c/p\u003e\n \u003cp\u003e(0.64-1.13)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e-2.12\u003c/p\u003e\n \u003cp\u003e(-2.26 to -1.98)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e888845\u003c/p\u003e\n \u003cp\u003e(628041-1197591)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e143.38\u003c/p\u003e\n \u003cp\u003e(101.31-193.18)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e502601\u003c/p\u003e\n \u003cp\u003e(376859-656923)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e76.36\u003c/p\u003e\n \u003cp\u003e(57.26-99.81)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e-2.11\u003c/p\u003e\n \u003cp\u003e(-2.25 to -1.97)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e5-9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e7235\u003c/p\u003e\n \u003cp\u003e(5447-9194)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e1.24\u003c/p\u003e\n \u003cp\u003e(0.93-1.58)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e5863\u003c/p\u003e\n \u003cp\u003e(4608-7130)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e0.85\u003c/p\u003e\n \u003cp\u003e(0.67-1.04)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e-1.23\u003c/p\u003e\n \u003cp\u003e(-1.38 to -1.08)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e603360\u003c/p\u003e\n \u003cp\u003e(453884-766573)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e103.40\u003c/p\u003e\n \u003cp\u003e(77.78-131.37)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e490210\u003c/p\u003e\n \u003cp\u003e(385233-595775)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e71.35\u003c/p\u003e\n \u003cp\u003e(56.07-86.71)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e-1.22\u003c/p\u003e\n \u003cp\u003e(-1.38 to -1.07)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e10-14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e4756\u003c/p\u003e\n \u003cp\u003e(3701-5723)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e0.89\u003c/p\u003e\n \u003cp\u003e(0.69-1.07)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e4832\u003c/p\u003e\n \u003cp\u003e(3978-5808)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e0.72\u003c/p\u003e\n \u003cp\u003e(0.60-0.87)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e-0.65\u003c/p\u003e\n \u003cp\u003e(-0.77 to -0.53)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e371333\u003c/p\u003e\n \u003cp\u003e(288914-446749)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e69.32\u003c/p\u003e\n \u003cp\u003e(53.93-83.40)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e378499\u003c/p\u003e\n \u003cp\u003e(311973-454290)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e56.78\u003c/p\u003e\n \u003cp\u003e(46.80-68.15)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e-0.64\u003c/p\u003e\n \u003cp\u003e(-0.76 to -0.52)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable3. The incidence, prevalence of childhood brain and central nervous system cancer and their AAPCs from 1990 to 2021 in five SDI regions.\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"996\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 89px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003eIncidence\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003ePrevalence\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\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: 89px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003eCases (n), 1990\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003eIncidence\u003c/p\u003e\n \u003cp\u003e(per 100 000 population), 2019\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003eCases (n), 2021\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003eIncidence\u003c/p\u003e\n \u003cp\u003e(per 100 000 population), 2021\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003eAAPC,\u003c/p\u003e\n \u003cp\u003e1990-2021\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003ep value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003eCases (n), 1990\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003ePrevalence\u003c/p\u003e\n \u003cp\u003e(per 100 000 population), 1990\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003eCases (n), 2021\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003ePrevalence\u003c/p\u003e\n \u003cp\u003e(per 100 000 population), 2021\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003eAAPC,\u003c/p\u003e\n \u003cp\u003e1990-2021\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003ep value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 89px;\"\u003e\n \u003cp\u003eHigh\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e5191\u003c/p\u003e\n \u003cp\u003e(4920-5477)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e2.80\u003c/p\u003e\n \u003cp\u003e(2.66-2.96)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e4751\u003c/p\u003e\n \u003cp\u003e(4352-5172\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e2.74\u003c/p\u003e\n \u003cp\u003e(2.51-2.99)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e-0.09\u003c/p\u003e\n \u003cp\u003e(-0.29 to 0.10)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e0.351\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e29869\u003c/p\u003e\n \u003cp\u003e(28179-31655)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e16.14\u003c/p\u003e\n \u003cp\u003e(15.23-17.11)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e32338\u003c/p\u003e\n \u003cp\u003e(29513-35287)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e18.68\u003c/p\u003e\n \u003cp\u003e(17.02-20.40)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e0.47\u003c/p\u003e\n \u003cp\u003e(0.14 to 0.80)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e0.005\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 89px;\"\u003e\n \u003cp\u003eUpper-middle\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e8201\u003c/p\u003e\n \u003cp\u003e(6390-9979)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e3.02\u003c/p\u003e\n \u003cp\u003e(2.35-3.68)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e6298\u003c/p\u003e\n \u003cp\u003e(4957-8149)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e2.74\u003c/p\u003e\n \u003cp\u003e(2.15-3.56)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e-0.43\u003c/p\u003e\n \u003cp\u003e(-0.70 to -0.16)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e0.002\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e31518\u003c/p\u003e\n \u003cp\u003e(24691-38231)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e11.62\u003c/p\u003e\n \u003cp\u003e(9.09-14.11)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e37338\u003c/p\u003e\n \u003cp\u003e(29245-48755)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e16.34\u003c/p\u003e\n \u003cp\u003e(12.74-21.40)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e0.97\u003c/p\u003e\n \u003cp\u003e(0.62 to 1.32)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 89px;\"\u003e\n \u003cp\u003eMiddle\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e12792\u003c/p\u003e\n \u003cp\u003e(8959-15882)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e2.22\u003c/p\u003e\n \u003cp\u003e(1.56-2.76)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e11247\u003c/p\u003e\n \u003cp\u003e(8540-114246)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e1.99\u003c/p\u003e\n \u003cp\u003e(1.51-2.53)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e-0.46\u003c/p\u003e\n \u003cp\u003e(-0.68 to -0.25)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e44424\u003c/p\u003e\n \u003cp\u003e(30943-55336\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e7.72\u003c/p\u003e\n \u003cp\u003e(5.37-9.61)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e55187\u003c/p\u003e\n \u003cp\u003e(41287-70926)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e9.81\u003c/p\u003e\n \u003cp\u003e(7.31-12.66)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e0.66\u003c/p\u003e\n \u003cp\u003e(0.42 to 0.91)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 89px;\"\u003e\n \u003cp\u003eLower-middle\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e5046\u003c/p\u003e\n \u003cp\u003e(3437-7807)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e1.06\u003c/p\u003e\n \u003cp\u003e(0.72-1.63)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e6890\u003c/p\u003e\n \u003cp\u003e(5226-8800)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e1.19\u003c/p\u003e\n \u003cp\u003e(0.90-1.53)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e0.40\u003c/p\u003e\n \u003cp\u003e(0.31 to 0.49)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e15688\u003c/p\u003e\n \u003cp\u003e(10763-24166)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e3.28\u003c/p\u003e\n \u003cp\u003e(2.25-5.04)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e25370\u003c/p\u003e\n \u003cp\u003e(19078-32625)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e4.41\u003c/p\u003e\n \u003cp\u003e(3.31-5.67)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e0.95\u003c/p\u003e\n \u003cp\u003e(0.89 to 1.01)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 89px;\"\u003e\n \u003cp\u003eLow\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e1851\u003c/p\u003e\n \u003cp\u003e(1093-3527)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e0.78\u003c/p\u003e\n \u003cp\u003e(0.46-1.47)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e3881\u003c/p\u003e\n \u003cp\u003e(2609-5212)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e0.84\u003c/p\u003e\n \u003cp\u003e(0.56-1.12)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e0.26\u003c/p\u003e\n \u003cp\u003e(0.05 to 0.47)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e0.014\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e5543\u003c/p\u003e\n \u003cp\u003e(3262-10675)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e2.31\u003c/p\u003e\n \u003cp\u003e(1.36-4.41)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e12543\u003c/p\u003e\n \u003cp\u003e(8366-16894)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e2.70\u003c/p\u003e\n \u003cp\u003e(1.80-3.64)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e0.50\u003c/p\u003e\n \u003cp\u003e(0.35 to 0.64)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 4. The mortality and DALYs of childhood brain and central nervous system cancer and their AAPCs from 1990 to 2021 in five SDI regions.\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"996\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 89px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003eMortality\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 105px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003eDALYs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\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: 89px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003eCases (n), 1990\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003eMortality (per 100 000 population),\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1990\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003eCases (n), 2021\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003eMortality\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(per 100 000 population), 2021\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 105px;\"\u003e\n \u003cp\u003eAAPC,\u003c/p\u003e\n \u003cp\u003e1990-2021\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003ep value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003eCases (n), 1990\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003eDALYs\u003c/p\u003e\n \u003cp\u003e(per 100 000 population), 1990\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003eCases (n), 2021\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003eDALYs\u003c/p\u003e\n \u003cp\u003e(per 100 000 population), 2021\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003eAAPC,\u003c/p\u003e\n \u003cp\u003e1990-2021\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003ep value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 89px;\"\u003e\n \u003cp\u003eHigh\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e2007\u003c/p\u003e\n \u003cp\u003e(1918-2093)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e1.08\u003c/p\u003e\n \u003cp\u003e(1.03-1.13)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e1250\u003c/p\u003e\n \u003cp\u003e(1166-1342)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e0.72\u003c/p\u003e\n \u003cp\u003e(0.67-0.77)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 105px;\"\u003e\n \u003cp\u003e-1.35\u003c/p\u003e\n \u003cp\u003e(-1.56 to -1.13)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e168640\u003c/p\u003e\n \u003cp\u003e(161068-176019)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e91.01\u003c/p\u003e\n \u003cp\u003e(86.92-\u003c/p\u003e\n \u003cp\u003e95.02)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e105002\u003c/p\u003e\n \u003cp\u003e(97759-112781)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e60.47\u003c/p\u003e\n \u003cp\u003e(56.19-65.05)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e-1.34\u003c/p\u003e\n \u003cp\u003e(-1.56 to -1.12)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 89px;\"\u003e\n \u003cp\u003eUpper-middle\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e5312\u003c/p\u003e\n \u003cp\u003e(4127-6468)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e1.96\u003c/p\u003e\n \u003cp\u003e(1.52-2.38)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e2237\u003c/p\u003e\n \u003cp\u003e(1830-2831)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e0.96\u003c/p\u003e\n \u003cp\u003e(0.79-1.22)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 105px;\"\u003e\n \u003cp\u003e-2.36\u003c/p\u003e\n \u003cp\u003e(-2.60 to -2.11)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e449233\u003c/p\u003e\n \u003cp\u003e(347823-547131)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e165.74\u003c/p\u003e\n \u003cp\u003e(128.14-201.99)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e187529\u003c/p\u003e\n \u003cp\u003e(153181-237547)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e81.25\u003c/p\u003e\n \u003cp\u003e(66.16-103.25)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e-2.37\u003c/p\u003e\n \u003cp\u003e(-2.62 to -2.13)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 89px;\"\u003e\n \u003cp\u003eMiddle\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e9091\u003c/p\u003e\n \u003cp\u003e(6333-11395)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e1.58\u003c/p\u003e\n \u003cp\u003e(1.10-1.98)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e5250\u003c/p\u003e\n \u003cp\u003e(4001-6553)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e0.92\u003c/p\u003e\n \u003cp\u003e(0.70-1.16)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 105px;\"\u003e\n \u003cp\u003e-1.81\u003c/p\u003e\n \u003cp\u003e(-1.99 to -1.63)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e769696\u003c/p\u003e\n \u003cp\u003e(535015-966212)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e133.69\u003c/p\u003e\n \u003cp\u003e(92.90-167.87)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e438456\u003c/p\u003e\n \u003cp\u003e(333624-548151)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e77.48\u003c/p\u003e\n \u003cp\u003e(58.79-97.13)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e-1.85\u003c/p\u003e\n \u003cp\u003e(-2.03 to -1.66)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 89px;\"\u003e\n \u003cp\u003eLower-middle\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e4036\u003c/p\u003e\n \u003cp\u003e(2722-6340)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e0.85\u003c/p\u003e\n \u003cp\u003e(0.57-1.33)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e4602\u003c/p\u003e\n \u003cp\u003e(3528-5889)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e0.80\u003c/p\u003e\n \u003cp\u003e(0.61-1.02)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 105px;\"\u003e\n \u003cp\u003e-0.20\u003c/p\u003e\n \u003cp\u003e(-0.37 to -0.02)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.639\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e340835\u003c/p\u003e\n \u003cp\u003e(229650-537485)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e71.39\u003c/p\u003e\n \u003cp\u003e(48.13-112.15)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e384614\u003c/p\u003e\n \u003cp\u003e(294364-492550)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e66.73\u003c/p\u003e\n \u003cp\u003e(50.99-85.52)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e-0.22\u003c/p\u003e\n \u003cp\u003e(-0.39 to -0.04)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e0.592\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 89px;\"\u003e\n \u003cp\u003eLow\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e1566\u003c/p\u003e\n \u003cp\u003e(926-2998)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e0.66\u003c/p\u003e\n \u003cp\u003e(0.39-1.25)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e3004\u003c/p\u003e\n \u003cp\u003e(1989-4071)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e0.65\u003c/p\u003e\n \u003cp\u003e(0.43-0.88)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 105px;\"\u003e\n \u003cp\u003e-0.06\u003c/p\u003e\n \u003cp\u003e(-0.32 to 0.20)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.027\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e133629\u003c/p\u003e\n \u003cp\u003e(79001-256546)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e55.87\u003c/p\u003e\n \u003cp\u003e(33.01-106.25)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e254615\u003c/p\u003e\n \u003cp\u003e(168184-345566)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e54.88\u003c/p\u003e\n \u003cp\u003e(36.30-74.44)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e-0.07\u003c/p\u003e\n \u003cp\u003e(-0.32 to 0.19)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e0.014\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\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":"[email protected]","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":"Epidemiology, central nervous system cancer, children, global burden of disease, Prediction","lastPublishedDoi":"10.21203/rs.3.rs-5814072/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5814072/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eObjectives\u003c/h2\u003e \u003cp\u003eWe assessed the global, regional, and national burden of childhood brain and central nervous system cancer from 1990 to 2021 (the latest year).\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eWe utilized data from the 2021 Global Burden of Disease Study, we analyzed trends in childhood brain and central nervous system cancer through joinpoint regression. We assessed the global burden of childhood brain and central nervous system cancer from various perspectives. Lastly, The Bayesian age-period-cohort model was employed to forecast future trends through 2030\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eChildhood brain and CNS cancers are the most common solid tumors and the leading cause of death in children. From 1990 to 2021, age-standardized incidence, prevalence, mortality, and DALYs have shown a decreasing trend. The incidence is slightly higher in boys than in girls and peaking at ages 0\u0026ndash;4 years, decreasing with age. The disease burden correlates with socio-demographic indices, with higher burdens observed in regions with higher socio-demographic indices. Future projections indicate a continued decline in incidence, prevalence, mortality, and DALYs.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eWhile the global burden of childhood brain and CNS cancer has significantly decreased due to medical advancements, it continues to be a major cause of childhood mortality. Further optimization of global health resources is crucial to alleviating this burden.\u003c/p\u003e","manuscriptTitle":"Global, regional, and national childhood brain and central nervous system cancer burden: An analysis based on the Global Burden of Disease Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-01-15 17:09:04","doi":"10.21203/rs.3.rs-5814072/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","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":"b3d347d9-a299-4a08-bdd7-0599dee4e733","owner":[],"postedDate":"January 15th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-07-14T10:08:38+00:00","versionOfRecord":[],"versionCreatedAt":"2025-01-15 17:09:04","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-5814072","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5814072","identity":"rs-5814072","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}