Trends and disparities in diffuse large B-cell lymphoma mortality among older adults in the United States (1999-2020): A CDC WONDER database analysis.

Abstract

e13734 Background: Despite treatment advancements, diffuse large B-cell lymphoma (DLBCL) remains a significant public health concern. This study evaluates temporal trends and demographic disparities in DLBCL mortality among U.S. adults from 1999 to 2020 to inform targeted interventions. Methods: This study analyzed age-adjusted mortality rates (AAMR) per 100,000 individuals using the CDC WONDER database for older adults (aged ≥55) with DLBCL. Joinpoint regression models were employed to calculate the annual percent change (APC) across various demographic groups, highlighting significant shifts in mortality trends. Mortality trends were stratified by age group (55–74 years and ≥75), gender, geographic region, state, and place of death. Results: Between 1999-2020, 53,956 deaths were recorded among adults (≥18) with DLBCL. Of these, 48,776 were in those aged ≥55. This group included 21,761 deaths in aged 55–74 and 27,015 deaths in aged ≥75. The AAMR for individuals aged 55–74 declined steadily from 1.6 in 1999 to its lowest point in 2007, followed by a gradual increase, reaching 3.1 in 2020. In contrast, for those aged ≥75, the AAMR started higher at 5.6 in 1999, declined until 2007, and then increased sharply to 12.5 by 2020. Among those aged 55–74, males consistently exhibited higher AAMRs. In 1999, the AAMR for males was 1.9, while for females it was 1.3. By 2020, the AAMR for males increased to 3.9 [annual average percent change (AAPC) 4.2%, p < 0.05), whereas females showed a more modest increase to 2.3 (AAPC: 3.6%, p < 0.05). For those aged ≥75, the gender gap was even more pronounced: in 1999, males had an AAMR of 6.5 compared to 4.7 for females. By 2020, the AAMR for males surged to 15.6 (AAPC: 4.9%, p < 0.05) vs. 9.5 in females (AAPC: 4.0%, p < 0.05). Geographically, the South region had the highest deaths (33.4%, AAMR: 2.6-2.8), followed by the Midwest (26.9%, AAMR:3.6–3.8). The West (22.3%, AAMR: 3.2–3.3) and the Northeast had the smallest share (17.4%, AAMR: 2.6–2.8). At the state level, Iowa (6.5), Minnesota (5.1), and Washington (5.0) had the highest AAMRs, whereas Nevada (1.6) had the lowest. Among adults ≥55, most deaths occurred in medical facilities (41.5%), followed by decedents' homes (34.4%), nursing homes (11.3%), and hospices (8.6%). For those ≥75, 33.2% died in medical facilities, 37.4% at decedents' homes, 15.3% in nursing homes, 9.0% in hospices, and 4.9% elsewhere. Conclusions: Significant differences exist in DLBCL mortality among older U.S. adults, with higher rates in those aged ≥75. Geographic analysis highlights regional and state-level variations, with the South and Midwest experiencing the highest burdens. We suggest a deeper analysis to understand the higher proportion of deaths in inpatient settings in patients aged ≥75. This trend may suggest delayed initiation of palliative care services or a greater disease burden among individuals aged ≥75.