Abstract
INTRODUCTION Multiple Myeloma (MM) is the second most fatal hematological malignancy after Acute Myeloid Leukemia (AML) and incidence rates are increasing in developed countries. Cardiovascular disorders in MM patients can be related to the disease itself or from treatment related complications. Stratified analysis of MM and HTN related mortality in elderly patients by demographic and geographical categorization are limited. In this study, we aim to analyze the trends in mortality due to MM and HTN in the United States.
METHODS We used CDC WONDER database to analyze death certificate data. We determined the crude mortality rates (CMRs) and age-adjusted mortality rates (AAMRs) per 1,000,000 individuals (≥55 years) using the International Classification of Diseases-10th (ICD-10) code C90.0 for MM and I10-15 for HTN. The trends in AAMR were assessed through annual percent change (APC) and the average annual percent change (AAPC) using Join point regression. A p value of 0.05 or less was deemed significant.
RESULTS From 1999 to 2023, a total of 30,425 deaths were reported due to MM and HTN in the Unites States, with most happening at the decedent's home (n = 10,603), followed by inpatient facilities (n = 8831) and nursing homes (n = 5947). The overall trend was upward with recorded AAPC of 4.73% (95% CI 2.62 to 6.88, p value = 0.00008). APC analysis showed three significant increasing trends (25.58%, 1.89% and 14.77%) in 1999-2001, 2001-2018, and 2018-2021 respectively. Data from four age groups was analyzed (55-64 years, 65-74 years, 75-84 years, and 85+ years) and all exhibited a rising trend with AAPC of 3.22%, 4.17%, 4.87%, and 4.74%).
Across genders, males demonstrated a higher AAPC [5.77% (95% CI 3.06 to 8.54, p value = 0.000022)] in contrast to women [4.07% (95% CI 1.94 to 6.25, p value = 0.000157)]. Similarly, men displayed significant inclines throughout the period with APC values of 34.73 % (1999-2001), 2.63% (2018-2021), whereas females showed only one significant trend (APC: 6.72%) in the later stages (2016-2023).
Racially, every group demonstrated a positive trend; however, the AAPC was highest in Caucasians [5.23% (95% CI 3.22 to 7.28, p value < 0.00001)], followed by Hispanic (3.66%) and African American (3.26%) patients. APC trend was different across racial groups with Caucasians showing notable inclines in the earlier periods [29.47% (1999-2001), 1.76% (2001-2017), and 12.84% (2017-2021).
Areas-based analysis revealed that the mortality trend was more prominent among urban populations than rural [AAPC 5.63% (95% CI 3.15 to 7.63, p value = 0.00001) vs 3.49% (95% CI 1.69 to 5.33, p value = 0.000127)]. The urban populations showed three positive APC trends of 27.09%, 1.86% and 16.44%, in 1999-2001, 2001-2018, and 2018-2020, while rural populations demonstrated only two (APC 2.03% and 12.71%) till 2020. Regionally, an upward trend was seen across all areas, but the western region demonstrated a higher AAPC of 5.08% (95% CI 2.27 to 7.89, p value = 0.00342), followed by Midwest (4.94%), South (4.10%), and Northeast (2.48%).
CONCLUSION Mortality due to Multiple Myeloma and Hypertension has increased significantly among older individuals over the past 25 years, compared to MM alone, for which the trend was opposite. Our study also showed marked disparities among demographic and geographic groups that underscore the need for targeted interventions and better policy making. Implementing screening protocols, making therapies like Autologous Stem Cell Transplantation (ASCT) easily accessible and cost effective are a few ways that can potentially benefit patients battling with MM.
