Background Myelodysplastic syndromes (MDS) are clonal hematopoietic disorders characterized by ineffective hematopoiesis and peripheral cytopenias, placing affected individuals at increased risk for severe infections. Despite advances in therapeutic management, infections remain a major cause of death in this population. However, national trends in infectious mortality among individuals with MDS have not been comprehensively evaluated. This study aims to assess long-term trends in infectious mortality in MDS patients in the United States using data from the CDC WONDER Multiple Cause of Death database from 1999 to 2023.

Methods Data were extracted from the CDC WONDER Multiple Cause of Death database, covering deaths between 1999 and 2023. The analysis included records listing Myelodysplastic Syndromes (ICD-10 code D46.x) and infectious diseases (ICD-10 codes A00–B99) as underlying or contributing causes of death. Age-adjusted mortality rates (AAMRs) per 1,000,000 population were calculated using the 2000 U.S. standard population. Joinpoint regression analysis was applied to determine annual percent change (APC) with 95% confidence intervals (CIs) to assess trends over time.

Results The overall age-adjusted mortality rate for infectious causes among individuals with MDS was 4.54 per million. Nationally, mortality rose significantly from 1999 to 2010 (APC: 1.92%), followed by a non-significant decline from 2010 to 2019 (APC: –1.55%) and a subsequent non-significant increase from 2019 to 2023 (APC: 4.90%).

Among females, the AAMR was 3.58 per million. Mortality declined from 1999 to 2004 (APC: –1.09%), showed a non-significant increase between 2004 and 2008 (APC: 6.47%), and then declined significantly from 2008 to 2023 (APC: –1.62%, p < 0.05). Males had a higher AAMR of 7.89 per million, with a significant increase from 1999 to 2010 (APC: 1.44%, p < 0.05) followed by a significant decline from 2010 to 2023 (APC: –1.48%, p < 0.05).

Among different races,Asian or Pacific Islander individuals had an AAMR of 4.61 per million; mortality rose non-significantly from 1999 to 2015 (APC: 0.85%) and declined significantly from 2015 to 2023 (APC: –4.62%, p < 0.05). Black or African American individuals had an AAMR of 4.65 per million, with a non-significant overall decline (APC: –0.50%). White individuals showed the highest racial AAMR at 5.51 per million, with a non-significant decline from 1999 to 2003 (APC: –1.91%), a significant rise from 2003 to 2009 (APC: 4.02%, p < 0.05), and a significant decline from 2009 to 2023 (APC: –1.37%, p < 0.05). Hispanic or Latino individuals had an AAMR of 3.96 per million, with a non-significant overall decline (APC: –0.73%).

Among the geographical regions,In the Northeast, the AAMR was 5.52 per million, with mortality increasing non-significantly from 1999 to 2011 (APC: 1.33%) and declining significantly through 2023 (APC: –1.65%, p < 0.05). The Midwest exhibited a similar AAMR of 5.51 per million, with a significant rise from 1999 to 2009 (APC: 2.52%, p < 0.05) and a subsequent significant decline (APC: –1.44%, p < 0.05). In the South, mortality increased significantly from 1999 to 2011 (APC: 1.80%, p < 0.05) and declined significantly thereafter (APC: –1.66%, p < 0.05). The West showed an AAMR of 5.46 per million, with a significant increase from 1999 to 2012 (APC: 1.46%, p < 0.05), followed by a significant decline through 2023 (APC: –1.49%, p < 0.05).Conclusion Infectious mortality among individuals with MDS in the United States has shown dynamic trends over the past two decades, with an initial rise followed by a general decline in recent years. Differences in mortality rates by sex, race/ethnicity, and geographic region underscore persistent disparities in outcomes and our data shows significant increased AAMR in Male sex, and White race. These findings highlight the critical need for tailored infection prevention strategies, ongoing surveillance, and equitable access to care to mitigate infectious risks in this high-risk population.

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2025
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