Introduction: Coagulation defects are a spectrum of disorders that impair the body's ability to regulate blood clotting and are prevalent and at times life-threatening disorders in the elderly. Coagulation defects are known to accelerate morbidity and mortality, especially in intensive care patients, trauma accidents, and those who suffer from acute respiratory failure.

Demographic and geographically stratified mortality trend analyses concerning coagulation defects in the elderly population of the United States are limited. This study examines national mortality trends in adults aged ≥ 65 years with coagulation defects from 1999 to 2023.

Methods: The CDC WONDER Multiple Cause-of-Death dataset (1999-2023) was used to analyze mortality trends in adults aged ≥ 65 years using ICD-10 codes for coagulation defects (D65-D69). Results were stratified by place of death, year, sex, age group, race, U.S. census region, and state. Age-adjusted mortality rates (AAMRs) were quantified per 100,000 persons by standardizing crude mortality rates (CMRs) with 95% confidence intervals (95%CI). Annual percent change (APC) and average annual percent change (AAPC) were calculated using Joinpoint regression software. A p-value of < 0.05 was defined as statistical significance.

Results: A total of 257,957 coagulation defect-related deaths occurred in adults ≥ 65 years in the United States from 1999 to 2023. Most of the deaths occurred in medical facilities (72.90%), followed by the decedent's home (12.07%), nursing home/long term care facilities (9.46%), hospices (3.47%), and other/place of death unknown (2.09%). Overall AAMRs initially decreased from 25.25 in 1999 to 22.25 in 2018 (APC: -0.73; 95%CI: -1.01 to -0.49), followed by an increase to 29.41 in 2021 (APC: 10.17; 95%CI: 7.30 to 11.79) and lastly another decrease to 26.28 in 2023 (APC: -4.18; 95%CI: -7.85 to -0.61). Men had a higher average AAMR (28.61) compared to women (20.41), and average CMRs increased with age (average CMR adults aged 65-74 years: 15.29; average CMR adults aged 75-84 years: 28.19; average CMR adults aged ≥ 85 years: 46.59). Racially, non-Hispanic (NH) Black/African Americans had the highest average AAMR (29.62), followed by NH American Indian/Alaska Native (27.28), Hispanic/Latino (23.65), NH White (23.11), and NH Asian/Pacific Islanders (22.25). NH Whites had their AAMRs increase from 24.15 in 1999 to 26.37 in 2023 (AAPC: 0.50; 95%CI: 0.25 to 0.69), while NH Black/African Americans had their AAMRs decrease from 33.95 in 1999 to 30.37 in 2023 (AAPC: -0.57; 95%CI:-0.91 to -0.28). Regionally, the West had the highest average AAMR (24.20), followed by the South (24.03), the Midwest (23.08), and the Northeast (23.03).

The West had its AAMRs increase from 23.62 in 1999 to 30.29 in 2023 (AAPC: 1.42; 95%CI: 1.08 to 1.76) while the Midwest had its AAMRs decrease from 25.04 in 1999 to 23.68 in 2023 (AAPC: -0.27; 95%CI: -0.49 to -0.05). From 1999 to 2023, statewide deaths were the highest in California, as it had a death toll of 28,803, accounting for 11.17% of deaths. From 1999 to 2020, state-specific AAMRs ranged from 15.50 in Louisiana to 38.24 in the District of Columbia. From 2021 to 2023, state-specific AAMRs extended from 17.14 in Louisiana to 50.59 in Colorado.

Conclusion: Coagulation defect-related mortality rates initially decreased from 1999 to 2018, followed by an increase to 2021, and lastly a decrease until 2023. Throughout the study duration, critical disparities in mortality rates between the demographic and geographic study groups were observed. The greatest mortality burden was observed in adults aged ≥ 85 years, men, NH Black/African Americans, residents of the West, and states previously mentioned. These disparities highlight the urgency for further research efforts to examine plausible causes and risk factors that lead to such disparities so that public health programs may be implemented to improve health outcomes, especially for at-risk groups.

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2025
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