Epidemiological trends in leukemia and heart failure-associated mortality: A CDC wonder database analysis

Abstract

Abstract Background Leukemia and heart failure (HF) are individually associated with high morbidity and mortality. However, the intersection of these conditions, whether due to cardiotoxicity from leukemia treatments or comorbid cardiovascular disease in leukemic patients, has not been sufficiently explored at the population level. We sought to evaluate age-stratified trends in co-morbid mortality due to leukemia and HF using national death certificate data from the CDC WONDER database. Methods A retrospective analysis was conducted using the CDC WONDER Multiple Cause of Death (MCD) database. Deaths listing any leukemia ICD-10 codes (C91-C95) and heart failure (I50.0, I50.1, I50.9) as causes of death were included. Mortality counts and age-adjusted mortality rates per 100,000 population were extracted. Annual Percent Changes (APCs) and Average Annual Percent Changes (AAPCs) were determined using Joinpoint regression. Results Between 1999 and 2020, a total of 38,319 deaths from Leukemia and HF were recorded among adults, with the overall AAMR increasing from 0.9 in 1999 to 1.0 in 2020, with an AAPC of 0.0421*. The most recent significant rise was observed from 2013 to 2020 (APC: 4.8109*). Males exhibited higher AAMRs than Females (1.2 vs 0.6). Mortality rates declined among individuals aged 65-74 (AAPC: -0.5775) and 75-84 years (AAPC: -0.0981), whereas increases were observed among those aged 55-64 (AAPC: 0.8764) and those above 85 years (AAPC: 0.0838). Among racial groups, Non-Hispanic (NH) Whites had the highest AAMRs (0.9), followed by NH Blacks (0.6), NH American Indians (0.5), Hispanics (0.3), and NH Asians (0.2). NH Whites experienced an overall rise in AAMRs (AAPC: 0.4699), whereas NH Blacks (AAPC: -0.4786) and Hispanics (AAPC: -0.3806) showed slightly decreasing AAMRs. The Midwest region had the highest mortality rates (1.0), followed by the Western region (0.8). Non-Metro areas had somewhat higher AAMRs (1.0) than Metro areas (0.8). Conclusion Our analysis reveals an age-associated increase in mortality burden from concurrent leukemia and heart failure, underscoring the need for vigilant cardio-oncology monitoring in older adults. Given the aging population and increased survival in leukemia, HF represents a growing contributor to late mortality in hematologic malignancies. Population-level strategies integrating hematologic and cardiovascular care pathways are needed to address these disparities.