Disparities in mortality from hematological malignancies with pulmonary embolism: Insights from US national data.

Abstract

e18604 Background: Hematological malignancies (HM) and pulmonary embolism (PE) create a critical clinical challenge, with PE being the second leading cause of death in cancer patients. The difficulty in diagnosing PE, due to symptom overlap with cancer, contributes to high mortality. This study aims to examine mortality disparities in HM and PE, highlighting their impact on patient outcomes, and address these disparities. Methods: Mortality data for HM with PE were retrieved from the CDC WONDER database (2013–2020) using ICD-10 codes C81-96 and I26 respectively. Crude mortality rates (CMRs) and age-adjusted mortality rates (AAMRs) per 100,000 population were calculated by age, race, gender, ethnicity, urbanization, place of death and region with 95% confidence intervals (CIs) for precision. Annual percentage changes (APCs) were evaluated using Joinpoint regression to assess disparities over time. Results: A total of 11,213 deaths from HM with PE were recorded, with mortality highest among older individuals. The 85+ age group had the highest CMR at 1.28 (APC = 3.09, 95% CI: 2.27–4.21; p < 0.01), followed by 75–84 years at 1.17 (APC = 1.60, 95% CI: 0.56–2.86; p < 0.01) and 65–74 years at 0.60 (APC = 0.36), while younger age groups (25–64 years) showed minimal or nonsignificant trends. Males exhibited a higher mortality burden (CMR: 0.18, AAMR: 0.17; APC = 1.09) compared to females (CMR: 0.15, AAMR: 0.13; APC = 1.29). Demographics revealed that White individuals had the highest CMR at 0.18 (AAMR: 0.14; APC = 1.04, 95% CI: 0.51–1.66; p < 0.01), while Black individuals had a higher AAMR (0.17) despite a lower CMR (0.15) and a nonsignificant APC (0.86, 95% CI: -0.82–2.99; p = 0.22). Non-Hispanic individuals accounted for most deaths (CMR: 0.19, AAMR: 0.14), whereas Hispanic or Latino individuals had a lower mortality burden (CMR: 0.06, AAMR: 0.09). Geographically, the West had the highest AAMR at 0.15 (APC: 1.99; p < 0.01), followed by the Midwest (AAMR: 0.15; APC: 0.61; p = 0.17), Northeast (AAMR: 0.14; APC: 0.92; p = 0.04), and South (AAMR: 0.14; APC: 0.67; p = 0.11). Urbanization trends showed the highest mortality in NonCore (nonmetro) areas (CMR: 0.21, AAMR: 0.14), while medium metro areas experienced the greatest mortality increase (APC = 1.26, 95% CI: 0.38–2.32; p < 0.01), followed by large fringe metro areas (APC = 0.97, 95% CI: 0.12–2.01; p < 0.01) and large central metro areas (APC = 0.83, 95% CI: 0.06–1.75; p < 0.01). Most deaths occurred in inpatient medical facilities (61.3%), followed by homes (16.3%) and nursing homes (8.2%). Conclusions: Significant mortality disparities in HM and PE affect older adults, Black individuals, males, and those in non-metro and medium metro areas, driven by limited healthcare access and socioeconomic factors. This underscores the need for targeted interventions in the elderly to improve care, early detection, and treatment, particularly as younger age groups show minimal trends.