Uneven gains: Disparities in pneumonia-associated mortality among myeloid leukemia patients in the United States, 1999–2020 — a CDC wonder and joinpoint analysis

Abstract

Abstract Introduction Patients with myeloid leukemia are highly susceptible to infectious complications due to their immunocompromised state from both disease burden and treatment. Pneumonia, in particular, is a leading cause of infectious mortality in this population. Despite its clinical significance, mortality patterns in patients suffering from both myeloid leukemia and pneumonia have not been comprehensively studied at the national level. Given the growing aging population, evolving treatment regimens, and unequal access to care across regions and demographics, understanding how mortality from this dual burden has changed over time is essential to improving outcomes.Methods We used CDC WONDER Multiple Cause of Death data from 1999 to 2020 to identify deaths with ICD-10 codes C92–C94 (myeloid leukemia) and J12–J18 (pneumonia) listed as any cause. Age-adjusted mortality rates (AAMRs) per 100,000 population were calculated using the 2000 U.S. standard population. Joinpoint regression analysis was performed to calculate Average Annual Percent Change (AAPC) and identify significant inflection points. Analyses were stratified by sex, race/ethnicity, ten-year age groups, U.S. census region, and 2013 urbanization classification.Results From 1999 to 2020, a total of 21,469 deaths were attributed to concurrent myeloid leukemia and pneumonia. The overall age-adjusted mortality rate (AAMR) remained relatively stable, with a rate of 0.54 per 100,000 in 2020. Joinpoint regression revealed four distinct periods: a significant decline from 1999 to 2005 (APC: –2.84%, 95% CI: –3.87 to –1.80, p < 0.001), a modest increase from 2005 to 2015 (APC: +1.23%, 95% CI: 0.80 to 1.66, p < 0.001), a subsequent decline from 2015 to 2018 (APC: –3.95%, 95% CI: –7.05 to –0.74, p = 0.021), and a sharp and significant rise from 2018 to 2020 (APC: +12.70%, 95% CI: 9.41 to 16.09, p < 0.001). Subgroup analysis revealed males experienced higher mortality than females (0.70 vs. 0.39 per 100,000 in 2020), with a significant decline over time (AAPC: –0.6%, p = 0.02) among males but not females. Patients aged 75–84 years exhibited a significantly increasing mortality trend (AAPC: +1.31%, p = 0.026), while the 85+ group remained stable. Racial trends showed Black individuals had the steepest increase (AAPC: +1.03%, p = 0.053), despite White individuals having the highest AAMR (0.53). Regionally, only the Northeast showed a statistically significant increase in mortality (AAPC: +0.97%, p = 0.006). Among urbanization categories, micropolitan areas had the highest AAMRs (0.64 per 100,000), with medium metro areas being the only group showing a significant rise (AAPC: +0.76%, p = 0.023).Conclusion Although national mortality rates from concurrent myeloid leukemia and pneumonia have remained stable overall, our analysis revealed a sharp and significant rise in recent years. Disproportionately increasing trends among older adults, Black individuals, and residents of medium metro and Northeastern areas reveal critical disparities in outcomes. These shifts likely reflect evolving treatment complexities and structural inequities in access to care. The late mortality surge underscores the urgent need for targeted prevention efforts, improved surveillance, and equitable resource allocation to protect high-risk subgroups in hematologic malignancy care.