Country‐Level Ecological Associations With Multiple Myeloma Prevalence and Death Rate: A Pan‐Database Study, 1990–2021

ABSTRACT Objective To assess country‐level ecological associations between multidimensional indicators and multiple myeloma (MM) prevalence and death rate using a pan‐database ecological analysis. Methods Country‐level data were assembled from 18 global databases, including the Global Burden of Disease Study, World Health Organization, and World Bank, to evaluate MM prevalence and death rate across 201 countries. Generalized linear regression was applied to estimate the associations between cumulative or contemporaneous exposures and MM outcomes, and the relative importance of candidate indicators was ranked accordingly. Spearman correlation analysis was used to examine the relationships between these indicators and MM. Heatmaps and scatter plots were generated to visualize the correlation patterns and improve interpretability. Results The study aggregated 72 socio‐economic and environmental indicators, 176 lifestyle and dietary indicators, and 27 physiological indicators. In the cumulative association analysis, high‐BMI exposure showed the strongest positive association with MM prevalence, followed by obesity prevalence, low physical activity, tobacco smoking, secondhand smoke, occupational asbestos exposure, and occupational benzene exposure. In contrast, sports time showed the strongest negative association, followed by alcohol use, delivery care, coffee, and low polyunsaturated fatty acid (PUFA) intake. Regarding the death rate, high‐BMI exposure showed the strongest positive association, followed by obesity prevalence, mean BMI, sugar, tobacco smoking, secondhand smoke, low physical activity, occupational asbestos exposure, and occupational diesel engine exhaust exposure. On the other hand, young children's vitamin A supplementation showed the strongest negative association, followed by sports time and alcohol use. The results for cumulative exposures were generally consistent with those for contemporaneous associations. Conclusion This study suggested that targeted public health measures may be informed by these country‐level ecological associations, including weight management, lifestyle‐related interventions, tobacco‐exposure reduction, childhood nutritional supplementation, and consideration of climate‐related health implications. These findings provide exploratory and hypothesis‐generating ecological evidence to support future epidemiological research and public health policy development for reducing the global burden of MM.