Mortality trends in patients with co-occurring hematologic malignancies and heart failure in the United States population: A 25-year analysis using the CDC wonder database

Abstract

Abstract Background: Hematologic malignancies (HM), also known as blood cancers, primarily include leukemia, lymphoma, and multiple myeloma. These cancers originate in the blood-forming tissues, such as the bone marrow or the cells of the immune system. Heart failure (HF) is defined as a complex clinical syndrome characterized by the heart's inability to pump blood effectively due to structural or functional impairments. A recognized bidirectional association exists between HM and HF, driven by shared risk factors, treatment-related cardiotoxicity, and other pathophysiological factors. Previous studies have analyzed mortality trends for each disease separately, but the combined burden of these conditions remains unexplored. Methods: We used the Multiple Cause of Death files (CDC WONDER database) to extract data for individuals aged ≥ 25 years (1999–2023). We used ICD-10 codes C81–C96 and I50 to identify cases with HM and HF, respectively. Age-adjusted mortality rates (AAMRs) were calculated per 100,000. Data were extracted and analyzed for demographics, geography, and period. We identified significant temporal changes in mortality trends by calculating APCs and AAPCs using the Jointpoint Regression Program. Statistical significance was defined as a p-value < 0.05. Results: A total of 117,930 deaths occurred from 1999-2023, with an overall AAMR of 2.12 deaths per 100,000. Males experienced higher AAMRs than females (AAMR 2.92 and 1.58, respectively). Non-Hispanic White individuals had the highest burden, followed by Non-Hispanic Black, American Indian. However, a notable trend in AAMR for American Indian or Alaska Native individuals is based on data from 2016 to 2023. NH-White individuals (AAMR=2.19) experienced 2.5 times greater mortality compared to Asians/Pacific Islander individuals (AAMR=0.88). The 65–84 age group (AAMR=7.04) had 140.8 times the burden of the lowest mortality age group, 25–44 (AAMR=0.05). The Midwest exhibited the highest AAMR (2.46) and the South had the lowest (1.94). States at or above the 90th percentile included Minnesota, Oregon, Nebraska, South Dakota, North Dakota, and Washington; those at or below the 10th percentile included Hawaii, Arizona, Nevada, Florida, New Mexico, and Alabama. Minnesota had the highest AAMR at 4.07, which was over three times higher than Hawaii's rate of 1.28, the lowest among all states. Noncore and Micropolitan counties had the highest AAMRs (2.54 and 2.49, respectively), while Large Central Metro and Large Fringe Metro counties had the lowest (1.85 and 1.94, respectively). Conclusion: There are significant disparities across demographic groups and geographic regions among individuals with co-occurring hematologic malignancies (HM) and heart failure (HF). These findings underscore the need for multidisciplinary care models, including the early integration of cardio-oncology services and routine cardiac surveillance within survivorship programs. Targeted efforts are necessary to address disparities in access to specialized care. Key words: Hematologic malignancies, heart failure, mortality trends, epidemiology