Hemostasis in crisis: Two-decade trends of mortality due to coagulation defects in the u.S. population; A CDC- wonder database analysis

Abstract

Abstract Introduction: Coagulation defects, purpura, and other hemorrhagic conditions encompass a range of disorders where the blood's ability to clot is impaired, leading to excessive bleeding. Thrombocytopenia is also a leading factor in several coagulation defects. These bleeding disorders contribute significantly to global morbidity and mortality, with a notable impact in the United States. This study aims to identify the demographic and regional mortality trends of these bleeding disorders in the U.S. from 1999 to 2023. Methodology: Data were retrieved from the CDC WONDER single cause-of-death database for the years 1999 to 2023, including individuals aged ≥55 years with a primary cause of death due to Coagulation defects, purpura, and other hemorrhagic conditions (ICD-10 codes: D65 - D69). We assessed age-adjusted mortality rates (AAMRs) per 100,000. Trends in age-adjusted mortality rates (AAMR) were assessed based on socio-demographic and regional variables using Joinpoint Regression software (JPR). Annual percentage change (APC) with 95% confidence intervals (CIs) for the AAMRs were calculated for the line segments linking a Joinpoint using a data-driven weighted Bayesian Information Criterion (BIC) model. Results: Between 1999 and 2023, a total of 53,799 deaths were recorded among U.S. adults aged 55 years and older, with an overall age-adjusted mortality rate (AAMR) of 2.9 per million (95% CI: 2.89–2.91). Over this period, mortality rates demonstrated a consistent decline (annual percent change [APC]: -1.76%, 95% CI: -2.02 to -1.55; p < 0.001). Females accounted for 53.8% of total deaths, while males comprised 46.2%. Notably, male mortality declined significantly between 2014 and 2023 (APC: -2.61%, 95% CI: -9.08 to -1.69; p < 0.05). When stratified by race, White individuals experienced a significant decrease in mortality from 1999 to 2023 (APC: -1.70%, 95% CI: -1.98 to -1.45; p < 0.001), while Hispanic populations showed a steeper decline over the same period (APC: -2.25%, 95% CI: -2.91 to -1.51; p < 0.001). Regionally, the South (Census Region 3) had the highest AAMR but also saw a notable reduction in mortality from 2012 to 2023 (APC: -3.05%, 95% CI: -8.06 to -2.11; p = 0.001). Among urbanization categories, micropolitan areas exhibited a significant downward trend between 1999 and 2023 (APC: -1.30%, 95% CI: -1.74 to -0.92; p < 0.001). At the state level, West Virginia reported the highest AAMR at 4.4 per million. Conclusion: Higher mortality in females and declining mortality trends among males and the White and Hispanic populations signify the need for targeted interventions. Census Region 3: South and West Virginia showed the highest AAMR, suggesting significant geographical variations among mortalities due to coagulation defects. These disparities are significantly associated with genetic predisposition, which highlights the need for remarkable healthcare policies.