Background Multiple myeloma (MM) is a cancer of plasma cells that accounts for about 10% of all hematologic cancers. With the global rise in diabetes mellitus (DM), it is increasingly common to encounter patients with both multiple myeloma and diabetes. The coexistence of these conditions presents a significant clinical challenge, as both diseases independently contribute to systemic complications such as renal impairment, cardiovascular disease, and increased infection risk. This study assesses the temporal trends in racial, gender, and regional disparities of DM-associated MM mortality in the United States (US) from 1999 to 2020.

Methods DM-related/ associated MM mortality from 1999 to 2020 was analyzed from the Centers for Disease Control and Prevention's Wide-Ranging Online Data for Epidemiologic Research (CDC WONDER). Age-adjusted mortality rate (AAMR) per 100,000 individuals were determined. We used joinpoint trend analysis to determine average annual percent change (AAPC) in AAMR trends.

Results Between 1999 and 2020, a total of 12,296 deaths were attributed to MM with concomitant DM, out of an overall 245,235 MM related deaths. Over the study period, the overall AAMR increased from 0.41 (95% CI, 0.37 - 0.45) to 0.49 (95% CI, 0.45 - 0.52) per 100,000 individuals [AAPC: 0.23 (95% CI, -0.25, 0.71]. Men showed higher AAMR [0.64 (95% CI, 0.63 - 0.66)] compared to women [0.34 (95% CI, 0.34- 0.36)]. Non-Hispanic Blacks had the highest AAMR [1.20 (95% CI, 1.16 - 1.25)] followed by Hispanics [0.63 (95% CI 0.59 - 0.67)] and Non-Hispanic Whites (0.37)(95% CI 0.36 - 0.38)]. AAMR showed notable regional variation, highest in the West [0.49 (95% CI, 0.47 - 0.51)] and Midwest [0.48 (95% CI, 0.46 - 0.5)] followed by the South [0.46 (95% CI, 0.44 - 0.47)]and Northeast [0.36 (95% CI, 0.34 - 0.38)]. Rural areas had higher AAMR [0.55 (95% CI, 0.53 - 0.57)] than urban [0.45 (95% CI, 0.44- 0.46)].The top three states with the highest AAMR are the District of Columbia [1.02 (95% CI, 0.74 - 1.37)] Mississippi [0.8 (95% CI, 0.69 - 0.92)] and Oklahoma [0.68 (95% CI, 0.59 - 0.78 )].

Conclusions Whereas substantial progress has been made in reducing deaths from multiple myeloma alone, mortality in patients with both MM and DM has stagnated, suggesting an area requiring urgent focus.We observed the highest AAMR in males, Non Hispanic Blacks, West, and rural areas of the US. Diabetes and poor glucose control are tied to worse survival in multiple myeloma, underscoring the need for improved diabetes management to enhance outcomes.

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2025
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