Comparative analysis of mortality trends in acute versus chronic myeloid leukemia in the U.S. population with time series projection: A CDC WONDER–based study (1999–2023).

Abstract

e18501 Background: Myeloid leukemias (ML) pose a significant public health concern globally and in the United States, particularly affecting older adults. Acute (AML) and chronic (CML) forms differ in clinical behavior and outcomes. This study compares mortality trends of AML and CML among the U.S. population from 1999 to 2023 and uses an autoregressive integrated moving average (ARIMA) model for predicting future trends. Methods: Data retrieved from the CDC WONDER database (1999-2023) included individuals aged ≥45 years. Mortality trends among people diagnosed with AML (C92.0) and CML (C92.1) individually were analyzed. We performed a head-to-head comparison of both groups. Age-adjusted mortality rates (AAMRs) per 100,000 population stratified by age, sex, race, Hispanic origin, U.S. Census regions, and 2013 urbanization categories were analyzed. Joinpoint regression was used to estimate Annual Percent Changes (APCs) and corresponding 95% CI. p < 0.05 was considered significant. R Software (Version 4.5.0) was used for time-series projections performed using an ARIMA model based on historical trends. Results: Between 1999-2023, a total of 207,992 deaths were attributed to AML (AAMR: 6.87) while CML accounted for 27,199 deaths (AAMR: 0.93). In both AML and CML, males showed higher mortality rates than females contributing to 56.9% and 55.4% of total deaths respectively. From 1999 to 2001, males and non-Hispanics showed significant upward trends in AML mortality with APC of 5.66 (95% CI: 2.09-8.78) and 4.91 (95% CI: 2.13-7.11), respectively. While in CML, from 1999-2006 males and non-Hispanics showed a notable decline in mortality with APC of -9.23 (95% CI: -11.22 - -7.77) and -9.22 (95% CI: -12.81 - -7.15), respectively. Whites affected by AML exhibited significant rising trends in mortality from 1999-2010 with APC of 2.14 (95% CI: 0.84-7.21). For AML, the Northeast region reported the highest AAMR 6.90 whereas for CML, the highest AAMR (1.0) was observed in the Midwest. Among states, North Dakota showed the highest AAMR of 8.8 in AML-group while Wyoming recorded the highest AAMR for CML at 1.2. ARIMA-based forecasting through 2030 showed relatively stable AML rates at approximately 6.68 (95% prediction interval: 6.09–7.28), whereas CML rates declined from 0.71 to 0.57 with wider uncertainty (95% prediction interval in 2030: −0.17 to 1.32), highlighting persistent disparities. Conclusions: AML mortality rose sharply, then steadily increased before declining, whereas CML mortality fell rapidly and later plateaued. These distinct trends indicates the need for population specific interventions and evaluation of therapeutic strategies.