Burden of chronic obstructive pulmonary disease among patients with hematological malignancies: A nationwide analysis of trends and outcomes

Abstract

Abstract Introduction: Due to common risk factors such as smoking history and pulmonary toxicities from therapy, chronic obstructive pulmonary disease (COPD) significantly increases non-cancer morbidity and deaths among people with hematologic malignancies. However, there is a paucity in data on long-term mortality trends associated with COPD and hematological malignancies. Objectives: We aim to evaluate mortality trends and demographic disparities associated with COPD and hematologic malignancies in U.S. adults aged 45 and above from 1999 to 2023. Methods: The Centers for Disease Control and Prevention's Wide-ranging Online Data for Epidemiologic Research (CDC WONDER) Multiple Cause of Death (MCD) database was queried to find mortality data of decedents aged 45 and above who had concurrent COPD (J40–J44) and hematologic malignancies (C81–C85, C88, C90–C95) between 1999 and 2023. Utilizing the 2000 U.S. standard population, age-adjusted mortality rates (AAMRs) per 100,000 people were computed. Moreover, annual percent changes (APCs) with their corresponding 95% confidence intervals (CIs) were calculated using Joinpoint regression analysis to assess trends; a p-value of less than 0.05 was deemed statistically significant. Results: According to this retrospective population-based study, mortality data of the United States from 1999 to 2023 revealed a total of 85,141 deaths among patients with COPD and hematologic malignancies. The majority of these individuals died in medical facilities (41.6%), followed by homes (26.1%), nursing homes or long-term care facilities (15.8%), other locations (9.8%), and hospice facilities (6.8%). Overall, a slight elevation was observed in AAMRs from 2.87 in 1999 to 2.94 in 2023 (AAPC: 0.0803; 95% CI: -0.6453 to 0.8113). Men exhibited a significantly higher AAMR (4.21) than women (1.86). When stratified by race, Non-Hispanic White individuals had the highest AAMR, exceeding those of Black or African American (1.80) and Hispanic or Latino (1.13) populations. Geographically, the Midwest recorded the highest AAMR (3.38), surpassing the West (2.76), the South (2.74), and the Northeast (2.43). Additionally, rural residents had greater AAMRs as compared to urban residents (3.72 vs. 2.59). Among the age groups, the 85+ individuals had the highest mortality rate of 13.24. State-level analysis revealed that Oklahoma, Nebraska, Kentucky, Vermont, Colorado, and West Virginia had the highest AAMRs, ranking in the top 90th percentile. Conclusion: COPD remains a significant cause of mortality in hematologic malignancy patients, particularly among men, adults ≥85 years, non-Hispanic Whites, and rural Midwestern residents. These results demonstrate the need for early COPD screening and integrated pulmonary care for high-risk groups, including older males, rural residents, and Midwestern populations with hematologic malignancies.