Abstract
Background: Myeloid leukemia (ML), a heterogeneous group of hematologic malignancies, encompasses acute and chronic forms and remains a major cause of leukemia-related deaths in the U.S., particularly among older adults. While subtype-specific trends (e.g., AML, CML) have been previously studied, long-term national data examining ML-related mortality as a whole, across various demographic and geographic subgroups, are lacking. This study aims to evaluate trends in ML-related mortality among U.S. adults aged ≥25 years from 1968 to 2016, stratified by sex, age, geographic region, and state.
Methods: A population-based analysis was conducted using the CDC WONDER database for the years 1968 to 2016. Deaths attributed to ML were identified using ICD-8, ICD-9, and ICD-10 codes. Age-adjusted mortality rates (AAMRs) were calculated per 100,000 persons using the 2000 U.S. standard population. Joinpoint regression was used to determine annual percent changes (APCs) and identify significant inflection points. Results were stratified by sex, age groups, U.S. Census regions, and state-level mortality.
Results: A total of 399,493 ML-related deaths occurred in adults aged ≥25 years during the study period. Nationally, AAMRs rose from 4.83 in 1968 to 5.5 in 1979 (APC: 1.20; p<0.000001), declined to 4.67 in 1988 (APC: –1.77; p<0.000001), rose again to 5.25 in 2000 (APC: 0.68; p=0.000021), and then declined to 5.01 by 2016 (APC: –0.25; p=0.0009). Sex stratification showed persistently higher mortality in males than females. Male AAMRs peaked at 7.07 in 1979 before declining to 6.48 in 2016, while female rates peaked at 4.47 and declined to 3.9. Mortality declined more steeply in females in the later decades. Age stratification revealed stark contrasts. Adults aged 25–44 years experienced marked declines over time, particularly in the 25–34 group, where crude rates dropped from 1.26 in 1975 to 0.5 in 2016 (APC: –1.99; p<0.000001). Conversely, the 75–84 and 85+ age groups exhibited increasing mortality, with AAMRs in the 85+ group rising from 21.85 in 1968 to 30.92 by 2016 (APC: 1.38; p<0.000001). These trends indicate shifting mortality burdens toward older populations. Regional stratification revealed persistent geographic disparities. The Northeast experienced an early surge followed by stabilization (AAMR: 5.67 in 1979 to 4.89 in 2016). The Midwest had a fluctuating pattern with overall higher mortality (e.g., AAMR peaked at 5.64 in 1978 and remained elevated). The South exhibited a more gradual decline after an initial increase, whereas the West showed a significant decline from its peak in the late 1970s (AAMR: 6.04 in 1976 to 4.83 in 2016). State-level analysis identified consistently high AAMRs in Midwestern and Northern states, including Minnesota, Iowa, North Dakota, and Washington, with Iowa recording the highest rate in the most recent period (1999–2016: 6.26; 95% CI: 6.02–6.50). In contrast, states such as Hawaii, New Mexico, Georgia, and the District of Columbia maintained the lowest AAMRs throughout the study. Period-specific analysis also revealed distinct epidemiological phases: a rising trend during 1968–1979, a notable decline in the 1980s, a mild resurgence in the 1990s, and gradual stabilization or decline in the 2000s. These shifts may reflect evolving diagnostic criteria, treatment accessibility, and therapeutic advances, including the introduction of targeted therapies for CML.
Conclusion: ML-related mortality in the U.S. displayed complex temporal trends from 1968 to 2016, marked by significant variation across age, sex, regions, and states. While improvements were seen in younger adults and females, elderly populations, especially those aged ≥75, continue to face increasing mortality. Geographical disparities highlight the need for targeted interventions and healthcare resource allocation. These findings emphasize the importance of precision public health strategies and continued research to mitigate the burden of ML-related deaths across vulnerable subpopulations.
