Introduction:

Myelodysplastic syndromes (MDS) are clonal bone marrow disorders with a major worldwide and U.S. health burden. Myelodysplastic syndromes (MDS) primarily affect older adults, with the average age at diagnosis being around 71 years. The global incidence is notably higher in men, with a World Standardized Incidence Rate (WSIR) of 3.4 per 100,000 person-years, compared to 1.6 in women. Renal failure (RF) and worsening patient outcomes can be due to immune dysregulation in Myelodysplastic syndromes. This study examines MDS with renal failure-related mortality trends among US adults from 1999 to 2023, considering demographic and geographic disparities.

Methodology:

The CDC WONDER multiple cause of death database was used to identify the U.S. population aged ≥65 years with myelodysplastic syndrome (ICD-10: D46) and renal failure (ICD-10: N17–N19) listed on death certificates from 1999 to 2023. Age-adjusted mortality rates (AAMRs) per 100,000 were extracted and annual percent change (APC) with 95 % confidence intervals (CIs) were calculated using Monte Carlo permutation test in JoinPoint regression analysis. Results were stratified by year, sex, race/ethnicity, urbanization, and Census regions.

Results:

Between 1999 and 2023; 18,698 deaths were attributed to MDS and RF as a multiple cause in patients aged 65 and above. There was an increase in annual AAMR with an overall AAPC of 0.99% (95% CI: 1.89 to 3.95; p = 0.5060) which is statistically non-significant. A statistically significant incline was observed specifically between 1999 and 2012 (APC: 4.12%; 95% CI: 2.84–5.40; p < 0.0001). This was followed by a non-significant decline from 2012 to 2015 and a modest, also non-significant, increase thereafter. Regionally, the Midwest recorded the highest AAMR (1.19) and steepest rise (AAPC: 1.80%; 95% CI: 0.23–3.41). The South (AAMR: 1.07; AAPC: 1.37%; 95% CI: –0.66 to 3.39) and West (AAMR: 0.97; AAPC: 0.47%; 95% CI: –2.75 to 1.26) followed. The Northeast showed the lowest AAMR (0.81) and slowest growth (AAPC: 0.42%; 95% CI: –0.43 to 1.28). States with the highest AAMR were South Dakota (3.5), Minnesota (3.3), and Vermont (3). Regarding sex, males had a higher AAMR (1.46) and AAPC (1.25%; 95% CI: –0.90 to 3.44; p = 0.2576) compared to females (AAMR: 0.91; AAPC: 0.77%; 95% CI: –0.89 to 2.47; p = 0.3662). Neither sex-specific trend was statistically significant. Among ethnic groups, Hispanic individuals showed a statistically significant decline in mortality (AAPC: –1.55%; 95% CI: –2.77 to –0.31; p = 0.0171). Non-Hispanic Whites had a stable trend (AAPC: –0.41%; 95% CI: –1.50 to 0.67; p = 0.4362). Non-Hispanic Blacks showed a non-significant decline (AAPC: –1.25%; 95% CI: –5.12 to 2.77; p = 0.5356), while other racial groups had a non-significant upward trend (AAPC: 1.25%; 95% CI: –1.05 to 3.80; p = 0.2891). Across urbanization levels, AAPCs ranged from –0.10% (95% CI: –0.83 to 0.64) in completely rural areas to 1.38% (95% CI: –1.04 to 3.87) in highly urbanized zones. No statistically significant trends were observed across any urbanization level (all p > 0.26).Conclusion:

Myelodysplastic syndromes with renal failure mortality in US adults aged ≥65 showed a significant rise from 1999 to 2012, followed by non-significant changes probably due to improvement in treatment strategies. The Midwest recorded the highest mortality rates and steepest increases, and males had higher rates than females. Hispanic individuals experienced a significant decline, while other ethnic groups and urbanization levels showed non-significant trends. These certain disparities stress upon the need for targeted intervention and a multidisciplinary approach.

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2025
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