Hematological malignancies in the United States: What do mortality trends reveal?

Abstract

e19030 Background: Hematological malignancies rank as the fifth most commonly diagnosed cancer globally and include leukemia, lymphoma, and myeloma. Their incidence rates have been growing making them a leading cause of global tumor burden. Despite this, the outcomes among different demographics remain underexplored. Here we aimed to investigate mortality trends attributable to hematological malignancies in the US stratified by year, sex, race, and region. Methods: We used CDC WONDER database to analyze death certificate data. We determined the crude mortality rates (CMRs) and age-adjusted mortality rates (AAMRs) per 1,000,000 individuals (≥25 years) using the International Classification of Diseases-10th (ICD-10) code C81-96. The trends in AAMR were assessed through annual percent change (APC) and the average annual percent change (AAPC) using Joinpoint regression. Results: A total of 1,463,046 deaths occurred due to lymphomas and hematopoietic malignancies in the US from 1999-2020 with an overall decreasing trend (AAPC = -1.36*). There was a gradual decrease in AAMR from 1999 to 2018 (APC: -1.66*, 95% CI = -1.74 to -1.57) followed by a non-significant rise till 2020 (APC: 1.51, 95% CI = -1.27 to 4.37). Males (40.62) had a significantly higher AAMR than females (23.72). Non Hispanic (NH) Whites had the highest AAMR (32.04), which were followed by Black or African American (31.31), Hispanics (22.50), NH American Indian or Alaskan Natives (21.11), and Asian or Pacific Islanders (16.65). Marked deviations were appreciated in the AAMRs of different regions (Midwest: 33.33, Northeast: 30.58, South: 30.13, West: 29.66). The states with the highest AAMR were Minnesota (34.83) and West Virginia (34.41), while the states with the lowest AAMR were Hawaii (23.69) and Nevada (26.43). Rural areas (32.47) had a higher AAMR than urban areas (30.53). Highest AAMR were found among the 85+ year age group (257.45). Conclusions: Hematological malignancy mortality in the US has declined overall since 1999, though recent trends suggest a plateau. Significant disparities persist by sex, race, age, and region, highlighting the need for targeted interventions to address these disparities, inequities and optimize outcomes. Deaths and age-adjusted mortality rates (AAMRs) per 1,000,000 for lymphoma and hematopoietic malignancies among adults in the United States between 1999 and 2020. Variable Deaths (n) AAMR (95% CI) Overall 1,463,046 30.86 (30.81 to 30.91) Female 646,732 23.72 (23.66 to 23.77) Male 816,314 40.62 (40.53 to 40.71) NH American Indian or Alaskan Native 5,449 21.11 (20.521 to 21.69) NH Asian or Pacific Islander 30,885 16.65 (16.46 to 16.84) NH Black or African American 138,484 31.31 (31.14 to 31.47) NH White 1,200,911 32.041 (31.98 to 32.09) Hispanics 84,590 22.50 (22.35 to 22.66) Urban : Rural 119,224 : 269,570 30.53 (30.47 to 30.58) : 32.47 (32.35 to 32.59)