Mapping the past, predicting the future: Hematologic malignancy mortality trends (1968–2023) and forecasts through 2050 in older u.S adults

Abstract

Abstract Introduction: Hematological malignancies remain a leading cause of cancer-related deaths among adults aged ≥65 years. Understanding long-term mortality trends is essential for guiding future public health strategies. This study analyzes mortality patterns from 1968 to 2023 and projects hematologic malignancy-related mortality rates through 2050. Methods: CDC WONDER data were extracted for adults aged ≥65 years with hematological malignancies (ICD-8: 200–209; ICD-9: 200–208; ICD-10: C81–C96) as the underlying cause of death from 1968 to 2023. Age-adjusted mortality rates (AAMR) per 100,000 were calculated using the 2000 U.S. standard population. Joinpoint regression identified significant trend changes and estimated annual percent change (APC) and average annual percent change (AAPC). Temporal mortality trends were modeled using ARIMA with Box-Cox transformation following stationarity testing by ADF and KPSS tests. Model fit was assessed through residual diagnostics and rolling-origin cross-validation. Forecasts were projected through 2050.Results: Over the 56-year period from 1968 to 2023, a total of 1890607 deaths from hematological malignancies were recorded among adults aged ≥65 years. AAMR increased from 86.4 per 100,000 in 1968 to a peak of 117.9 in 2000, followed by a steady decline to 83.6 in 2023. Joinpoint regression revealed three significant trend phases: a modest increase from 1968–1981 (APC +0.56%; 95% CI: 0.31 to 0.82), a sharper rise from 1981–1995 (+1.45%; 95% CI: 1.25 to 1.65), and a significant decline from 2000–2023 (–1.41%; 95% CI: –1.48 to –1.34). The overall AAPC was –0.07% (95% CI: –0.19 to 0.06; p=0.28), indicating no significant long-term change in mortality over the full study period. Males exhibited higher AAMR than females (131.6 vs. 80.3 per 100,000). Mortality rates initially increased in both sexes, followed by significant declines beginning in the late 1990s. Among females, the most pronounced decline occurred from 1999–2023 (APC: –1.68%; 95% CI: –1.75 to –1.60). In males, a similar downward trend was observed from 2001–2023 (APC: –1.37%; 95% CI: –1.45 to –1.28). AAPC was significantly negative in females (–0.18%; 95% CI: –0.30 to –0.05), but not statistically significant in males. White individuals had a higher overall AAMR for hematologic malignancies compared to Black individuals (102.9 vs. 89.1 per 100,000). While AAMRs remained relatively stable in Whites (AAPC: –0.05%; p = 0.45), they increased significantly among Black individuals (AAPC: +0.37%; p = 0.004). However, both groups experienced significant declines in more recent years. Regionally, the Midwest reported the highest AAMR at 108.30 (95% CI: 105.96 to 110.62), reflecting a disproportionately greater mortality burden compared to other regions. At the state level, Hawaii had the lowest AAMR (73.07), while Minnesota had the highest (112.95). Forecasting models project that the AAMR will reach approximately 86.04 in 2050, though there is considerable uncertainty (95% CI: –96.49 to 161.94). Conclusion: Over the past five decades, AAMR for hematologic malignancies among U.S. adults aged ≥65 years initially increased, peaking in 2000, followed by a sustained decline through 2023. Although the overall mortality trend was not statistically significant, notable disparities were observed across sex, race, and geographic region. Males and White individuals consistently experienced higher mortality rates than females and Black individuals, respectively. However, mortality declined more significantly among females, whereas AAMR in Black populations increased over time. Regionally, the Midwest bore the highest mortality burden, with considerable state-level variation. Hawaii reported the lowest AAMR and Minnesota the highest. Forecasting models project a moderate increase in AAMR by 2050, although long-term projections are subject to wide uncertainty. These findings highlight persistent disparities and highlight the need for targeted public health interventions to reduce disparities and sustain improvements in hematologic cancer outcomes.