Background

Acute lymphoblastic leukemia (ALL) and acute myeloid leukemia (AML) are the most common forms of acute leukemia affecting both pediatric and adult populations. Understanding national mortality trends in these diseases is critical for guiding clinical practice and informing public health strategies. This study aims to compare long-term mortality patterns of ALL and AML in the United States from 1999 to 2020, with a focus on demographic disparities.Methods Mortality data for ALL and AML from 1999 to 2020 were obtained from the CDC Wide-Ranging Online Data for Epidemiologic Research (CDC WONDER) using ICD-10 codes C91.0 (ALL) and C92.0 (AML). Age-adjusted mortality rates (AAMRs) and crude mortality rates (CMRs) per 1,000,000 population were calculated. Trends were analyzed using the Joinpoint Regression Program, and average annual percent changes (AAPCs) were compared across subgroups. Statistical significance was set at p < 0.05.Results Between 1999 and 2020, there were 34,893 ALL-related deaths and 207,817 AML-related deaths, with AML accounting for over six times more deaths. ALL mortality showed a declining trend (AAPC: -0.60%, 95% CI: -0.80 to -0.40, p < 0.05), while AML mortality increased over time (AAPC: 0.50%, 95% CI: 0.10 to 0.91, p = 0.01). The overall difference in trends between ALL and AML was statistically significant (p = 0.000444). For ALL, males experienced higher mortality than females (n = 19,719 vs. 15,120), but the decline in mortality was steeper in males (AAPC: -0.70%, 95% CI: -0.96 to -0.41, p < 0.000001) than in females (AAPC: -0.53%, 95% CI: -0.86 to -0.17, p < 0.05). In AML, male mortality was also higher (n = 117,299 vs. 90,518), with an increasing trend in males (AAPC: 0.60%, 95% CI: 0.46 to 0.75, p < 0.000001), while female mortality remained relatively stable (AAPC: 0.08%). Racial disparities were observed in both types of leukemia. For ALL, White individuals had higher mortality than African Americans (n = 23,331 vs. 2,948), though the decline was greater among African Americans (AAPC: -0.81%) compared to Whites (AAPC: -0.10%). In AML, mortality was again highest among Whites (n = 171,680), followed by African Americans (n = 16,472), with a greater rate of increase in Whites (AAPC: 0.67%) compared to African Americans (AAPC: 0.45%). Urban populations experienced higher mortality for both ALL (n = 29,304) and AML (n = 172,111) than rural populations (ALL: n = 5,589; AML: n = 35,706). However, rural areas showed a steeper decline in ALL mortality (AAPC: -0.67%, 95% CI: -1.39 to -0.24, p = 0.04) compared to urban areas (AAPC: -0.55%, 95% CI: -0.79 to -0.30, p < 0.05). In contrast, AML mortality increased more rapidly in rural areas (AAPC: 0.75%, 95% CI: 0.47 to 1.09, p < 0.05) than in urban populations (AAPC: 0.46%, 95% CI: 0.32 to 0.64, p < 0.05).

Conclusion Over the past two decades, mortality trends for acute leukemia in the United States have diverged, with ALL showing a modest decline and AML demonstrating a rising trend. Significant disparities in mortality by sex, race, and geographic location persist, highlighting the need for targeted public health interventions and equitable healthcare strategies aimed at improving leukemia outcomes across all populations.

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2025
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