Intersecting risks: Myelodysplastic neoplasms and cardiovascular disease mortality in older adults across the United States, 1999–2020.

Abstract

e18581 Background: Myelodysplastic syndrome (MDS) predominantly affects older adults and carry substantial mortality. Cardiovascular disease (CVD) is a leading competing cause of death in MDS; however, long term national trends and demographic disparities in MDS-associated CVD mortality remain unexplored. We aimed to evaluate temporal, demographic, and geographic patterns of MDS and CVD-related mortality among older adults in the United States. Methods: We conducted a population-based descriptive study using the CDC WONDER database from 1999–2020. Deaths among individuals aged ≥75 years with both MDS (ICD 10: D46) and CVD (ICD 10: I00–I99) listed as underlying or contributing causes were included. Deaths were standardized to the U.S. population in 2000 in order to establish AAMRs. Temporal trends were assessed using Joinpoint regression to estimate annual percent change (APC) and average annual percent change (AAPC). Analyses were stratified by sex, race/ethnicity, age group, urbanicity, census region, place of death, and state. Results: From 1999 to 2020, 72,206 deaths occurred due to combined MDS and CVD among adults aged ≥75 years. Overall mortality increased from 1999–2010 (APC 2.17%, 95% CI 1.68–2.67), declined from 2010–2018 (APC −2.48%, 95% CI −3.33 to −1.63), and rose again from 2018–2020, though this increase was not statistically significant. Mortality rates were consistently higher in men than women (men: AAPC 0.19%; women: AAPC −0.38%). Non-Hispanic White individuals exhibited the highest mortality burden (AAPC 0.66%, 95% CI −0.06 to 1.39), whereas rates were lowest among Black adults (AAPC −0.16%, 95% CI −1.00 to 0.69). The highest mortality occurred in the 80–84-year age group (overall AAPC 0.47%, 95% CI −0.74 to 1.69). Geographically, AAMR was highest in Midwest (18; 95% CI 17.7 to 18.8) and was lowest in the South (14.2; 95% CI 14 to 14.4). State-level AAMRs varied greatly, ranging from 8.16 in Louisiana to 25.72 in Vermont. Non-metropolitan areas showed a higher AAPC (0.49%, 95% CI −0.30 to 1.30) compared with metropolitan areas (0.44%, 95% CI −0.10 to 0.99). Conclusions: Our findings demonstrate marked disparity in mortality rates of MDS associated CVD mortality across age, regions, race and geography. These highlight the need of care models and prioritizing targeted interventions for high-risk populations. Age-adjusted mortality rates (AAMR) according to demographic variables among the US population 1999-2020. Demography Age Adjusted Rates Age Adjusted Rate Lower 95% Confidence Interval Age Adjusted Rate Upper 95% Confidence Interval Overall Year 1999-2020 16.7 16.5 16.8 Sex Male 25.6 25.4 25.9 Female 11.4 11.2 11.5 Census Region Northeast 17.7 17.4 18 Midwest 18 17.7 18.3 South 14.2 14 14.4 West 18.4 18.1 18.7 Race American Indian or Alaska Native 8.4 7.2 9.7 Asian or Pacific Islander 11.5 11 12.1 Black or African American 9.8 9.4 10.1 White 17.5 17.4 17.7