Trends and disparities in renal failure and multiple myeloma–related mortality among adults aged 55 and above in the United States from 1999–2020: A CDC-WONDER analysis.

Abstract

e19567 Background: At diagnosis, around 20% of patients with multiple myeloma (MM) have impaired renal function. Renal failure (RF) is the leading cause of death in these patients, particularly among older adults. Despite the established correlation, mortality trends across various demographics in the United States is underexplored. This study examines mortality trends and discrepancies in MM and RF among older adults aged 55 and above from 1999 to 2020. Methods: Using the ICD-10 codes C90.0 (Multiple myeloma - Malignant neoplasms) and N17-N19 (Renal failure), we extracted crude mortality rate (CMR), and age adjusted mortality rate (AAMR) from CDC WONDER, stratified by gender, age, race, geographic areas, and urban/rural status from 1999 to 2020. Joinpoint regression was used to calculate annual percentage change (APC) and average annual percentage changes (AAPC). Results: A total of 49043 deaths were reported throughout the study period, with an overall AAMR of 3.11. A variable trend in mortality was observed, with an increasing trend from 1999 to 2003 (APC: 2.31) followed by a significantly decreasing trend from 2003 to 2020 (APC: -3.03;). The AAMR for males was double that of females (4.14 vs. 2.35), plus the rate of decline was less pronounced for males (AAPC: -1.80) than females (AAPC: -2.47). Non-Hispanic (NH) Blacks have the highest AAMR (6.89) and NH Asians the lowest (1.61). However, NH Whites showed the slowest rate of decline (AAPC -1.91). Geographically, the Midwest had the highest AAMR (3.24). Rural areas had slightly higher AAMRs than urban areas (3.17 vs. 3.06). The District of Columbia had the highest AAMR of 5.29. Most deaths occurred in medical facilities (55.51%). Lastly, the age group 85+ years old showed the highest CMR of 7.16 (AAPC= -0.74). Conclusions: Although there has been an overall decline in mortality related to MM and RF, the rate of decline has slowed in recent years. Higher AAMR was observed in males, the Midwest, the District of Columbia, rural areas, Black or African Americans, and geriatric age groups, indicating a need for targeted interventions in these groups to mitigate fatalities caused by MM and RF. Variable Variable Deaths (n) Total AAMR (95% CI) Deaths (n) Total AAMR (95% CI) Overall 49043 3.11 (3.08 to 3.14) Urbanization Sex Urban 40117 3.06 (3.03 to 3.09)  Female 21313 2.35 (2.32 to 2.38) Rural 8926 3.17 (3.11 to 3.24)  Male 27730 4.14 (4.09 to 4.19) Race/Ethnicity Census Region NH American Indians 256 3.12 (2.72 to 3.52)  Northeast 9267 2.99 (2.93 to 3.05) NH Asians 960 1.61 (1.50 to 1.71)  Midwest 11408 3.24 (3.18 to 3.30) NH Blacks 9746 6.89 (6.75 to 7.03)  South 17961 3.07 (3.03 to 3.12) NH White 35092 2.77 (2.74 to 2.80)  West 10407 3.07 (3.01 to 3.13) Hispanics 2906 2.57 (2.48 to 2.67)