Abstract
Introduction Acute myeloid leukemia (AML) is a rapidly progressive hematological malignancy characterized by the clonal proliferation of myeloid blasts, which may result in an immunocompromised state from neutropenia due to bone marrow failure. Sepsis remains a significant and potentially life-threatening complication among patients with AML, with a markedly higher incidence compared to the general population. Despite this well-established association, there is limited population-level data on long-term trends in mortality in adults aged 55 years and older in the U.S. This study aimed to evaluate temporal trends in mortality primarily in adults aged ≥ 55, a demographic that accounts for the majority of combined mortality from AML and sepsis.
Methods We utilized the CDC WONDER database to extract data on mortality in U.S. adults aged ≥ 55 from 1999 to 2023, focusing on deaths attributed to both AML and sepsis. ICD-10 codes C92.0 for AML and A.40-A.41.9 for sepsis were used, and data were stratified into age groups, sex, and race/ethnicity. Age-adjusted mortality rates (AAMRs) were calculated per 100,000 population. Temporal trends in mortality were assessed using Joinpoint regression analysis by calculating annual percentage changes (APCs) and average annual percentage changes (AAPCs). P-value (p) < 0.05 was considered statistically significant.
Results From 1999 to 2023, a total of 28888 deaths were reported in the age group (≥ 18). Among these, 22608 were in the age group (≥ 55), and 6280 were in the age group (18-54) in the U.S. who died of sepsis and AML. In the age group (≥ 55), 14955 deaths were in the (55-74) age group and 7613 in the (≥ 75) age group. For the age group (≥ 55), average adjusted mortality rate (AAMR) was 1.16, which increased from 1.05 in 1999 to 1.21 in 2023 (AAPC: 0.56, p = 0.04). Initially, from 1999 to 2019, there was a significant increase in AAMR (APC: 1.01, p = 0.01), followed by a non-significant decline till 2023 (APC: -2.05, p = 0.18).
In subgroup analysis, adults aged 55-74 had an average AAMR of 1.01 with no significant change over time (AAPC: -0.32, p = 0.19). In contrast, those ≥ 75 had a higher average AAMR of 1.54, rising from 1.4 in 1999 to 1.95 in 2023 (AAPC: 1.24, p = 0.001). This group saw an initial decline (1999–2003, APC: –4.29; p = 0.005), followed by a significant increase (2003–2019, APC: 3.05; p = 0.001), and a non-significant drop thereafter (2019–2023, APC: –0.24; p = 0.84).
By sex, males aged ≥55 had a higher average AAMR (1.59) than females (0.84). AAMR significantly increased in females from 0.8 to 0.91 (AAPC: 1.05; p <0.001), while males showed a non-significant rise from 1.45 to 1.60 (AAPC: 0.34; p = 0.05).
Racial disparities were also evident: non-Hispanic (NH) Whites had the highest average AAMR (1.19), followed by NH Black/African American (1.16) and Hispanic/Latino (0.95). A significant increase in AAMR was observed in NH Black/African American from 1999 to 2023 (AAPC: 0.83, p = 0.009), followed by NH White (AAPC: 0.55, p = 0.02), and a non-significant increase in Hispanic/Latino (AAPC: 0.50, p = 0.33).
Conclusion In conclusion, the mortality from AML-related sepsis remains disproportionately high among older adults, particularly in males and individuals aged ≥ 75, and NH White individuals. Despite some recent improvements, there are concerning trends indicating rising mortality rates among females, the elderly, and NH Black/African American individuals. This highlights the need for age, sex, and race-specific strategies to reduce mortality in this high-risk population.
