Introduction:

Hematologic malignancies—including multiple myeloma, non-Hodgkin lymphoma, and leukemia—are more prevalent in individuals with diabetes mellitus (DM), likely due to chronic inflammation, oxidative stress, and immune dysregulation. These mechanisms not only increase cancer risk but also impair treatment response and survival. Despite growing clinical attention to this overlap, national mortality trends for hematologic cancers in the diabetic population remain inadequately defined. This study aims to characterize these trends using national mortality data from the CDC WONDER database.

Methods:

We performed a retrospective analysis of U.S. death certificate data (CDC WONDER) from 1999 to 2023 for adults aged ≥25 years. Hematologic malignancies (ICD-10 codes C81–C96) listed as the underlying cause of death, with diabetes mellitus (E10–E14) as a contributing cause, were included. Age-adjusted mortality rates (AAMRs) per 100,000 population were calculated. Joinpoint regression was used to assess trends through Annual Percent Changes (APCs), stratified by gender, race/ethnicity, region, urbanization level, and state.

Results:

A total of 105,969 deaths were attributed to hematologic malignancies in individuals with DM. The overall AAMR rose from 1.75 in 1999 to 1.88 in 2005 (APC: +1.64%; 95% CI: 0.55–2.73), then declined to 1.81 in 2018 (APC: -0.70%; 95% CI: -1.07 to -0.33). During the COVID-19 pandemic, AAMRs sharply increased, peaking at 2.51 in 2021 (APC: +13.44%; 95% CI: 7.18–20.06), followed by a decline to 2.24 in 2023 (APC: -5.74%; 95% CI: -10.28 to -0.96). Males had consistently higher mortality than females (2.64 vs. 1.33). Non-Hispanic Black individuals had the highest AAMR (2.40), followed by Hispanic (2.04), non-Hispanic White (1.85), and non-Hispanic Asian/Pacific Islander (1.24) populations. Mortality was higher in non-metropolitan areas (2.19) than metropolitan areas (1.74), with the Midwest showing the highest regional AAMR (2.11) and the Northeast the lowest (1.59). States in the top 90th percentile for mortality included Oklahoma, Minnesota, Nebraska, and West Virginia. The ≥65 age group bore the greatest burden, with 89,515 deaths and an average AAMR of 8.26.

Conclusion:

Over the past 24 years, mortality from hematologic malignancies among U.S. adults with diabetes has shown a fluctuating yet overall increasing trend, with a sharp spike during the COVID-19 pandemic. Marked disparities persist, with disproportionately higher mortality in males, non-Hispanic Black populations, rural communities, and the elderly. These patterns likely reflect systemic inequities in healthcare access, delayed cancer detection, and the complex comorbidity burden in diabetic patients. Addressing these disparities requires comprehensive strategies that include earlier cancer screening in diabetic populations, improved chronic disease management, and equitable access to specialized oncology care. This study highlights an urgent need for targeted public health interventions to reduce preventable mortality and improve cancer outcomes in this high-risk group.

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2025
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