Trends and disparities in cardiovascular mortality among patients with hematological malignancies: A 22-year CDC-WONDER analysis (1999-2020).

Abstract

e23177 Background: Hematological malignancies (HM) are the fourth most diagnosed cancer in developed countries, with rising incidence. Patients with HM face increased cardiovascular (CV) risk, making CV disease the second leading cause of death in this group. Addressing modifiable risk factors is crucial. This study analyzed CV mortality in HM (HM-CVM) using a large death certificate database. Methods: CDC-WONDER (1999-2020) was used to analyze HM-CVM in individuals aged > 25 using ICD-10 codes. Age-adjusted mortality rates (AAMR) per 1,000,000 were assessed, and trends were analyzed using Joinpoint regression to calculate annual and average annual percentage changes (APC, AAPC). Results: AAMR declined from 25.6 (n = 4512) in 1999 to 17.03 (n = 4564) in 2020. Females had a significant decline (APC: -4.36), followed by a non-significant rise (APC:1.17,2014-2020; AAPC: -2.81). Males showed an overall decline (AAPC: -1.75, p < 0.000001), with a non-significant drop (1999-2003), significant decline (APC: -4.34, 2003-2010), slowing until 2017(APC: -1.4), and a significant increase in 2017-2020 (APC: 4.23). Across races, AAMR significantly declined (1999-2020): AAPCs of -3.23 (Asian/Pacific Islanders, A-PI), -1.72 (African Americans, AA), and -2.14 (White Americans, WA). A-PI saw a decline until 2017 (APC: -5.06), followed by a non-significant rise (APC: 8.47). AA (APC: -3.78) and WA (APC: -3.6) had significant declines until 2014, then trend reversals (APC: 3.62 for AA, 1.6 for WA,2014-2020). Subgroup analysis showed significant declines across genders (p < 0.000001). A-PI females declined (APC: -6.33) but had a non-significant rise post-2018 (APC: 21.51; AAPC: -3.98). AA (APC: -4.73) and WA (APC: -4.19) females declined until 2014, followed by an increase in AA females (APC: 4.52) but no change in WA females (APC: 0.77). Both AA and WA females had significant overall declines (AAPC: -2.17, -2.80). A-PI males (AAPC: -3.22) had no joinpoints. AA males (AAPC: -1.54) declined until 2013 (APC: -3.14), followed by a non-significant rise. WA males (AAPC: -1.68) had varied trends, with a decline (APC: -4.15, 2002-10) and a rise (APC: 4.53, 2017-20). Significant declines were seen across regions (AAPCs: -2.53 in the Northeast, -1.79 in the Midwest, -1.87 in the South, and -2.51 in the West). The Northeast (-4.06 APC) and West (-3.82 APC) had significant declines until 2013-2014, then stabilized. The Midwest (APC: 2.92) and South (APC: 2.48) showed trend reversals post-2016 and 2014, respectively. Conclusions: HM-CVM declined significantly, but recent trend reversals among males, AA, and the Midwest/South highlight persistent disparities. To address these gaps, ongoing surveillance and targeted interventions are needed.