Racial Disparities in Mortality Trends from Acute Myeloid Leukemia: A Population-Based Study in the United States between 2000 and 2019

Abstract

Background: Acute myeloid leukemia (AML) results from the clonal alteration of hematopoietic progenitors and is the most prevalent form of acute leukemia in adults. Despite breakthroughs in therapeutic regimens and advancements in overall survival, the improvement has not been equally distributed among racial and ethnic groups, and the 5-year survival rate for adults with AML remains at 27%. Interestingly, the incidence is greater among whites when adjusted for age compared to other races. Racial inequalities in patients with solid malignancies are well-studied, but studies assessing racial disparities in hematologic malignancies are lacking. Therefore, we conducted a retrospective analysis of mortality trends among all racial groups in the United States from 2000 to 2019. Methods: We conducted a retrospective analysis employing the Centers for Disease Control and Prevention's (CDC) WONDER database, which covers the entire US population. Using the multiple cause of death database (International Classification of Disease - 10th revision), we identified all patients who died of AML (C92.0.x listed as the underlying cause of death) of all races (White, Black, Asian, or Pacific Islander, and American Indian or Alaska Native) between 2000 and 2019 in the United States, regardless of ethnicity and gender. Age-adjusted mortality rates were calculated per 1000,000 persons (PMP), standardized to the US census data from 2000, and stratified by race. Results: A total of 176,526 AML deaths were identified in all races, with an overall age-adjusted mortality of 26.7 PMP between 2000 and 2019. Over the same period, we identified a total of 156,453 deaths, 14,079 deaths, 5,280 deaths, and 714 deaths in the White, Black, Asian or Pacific Islander, and American Indian or Alaska Native populations, respectively. The overall age-adjusted mortality were 27.7 PMP, 20.9 PMP, 19 PMP, and 13.6 PMP in the White, Black, Asian or Pacific Islander, and American Indian or Alaska Native populations, respectively. Over this period, the age-adjusted mortality increased by 3 % in White (from 26.1 PMP in 2000 to 27 PMP in 2019), 3 % in Black (from 20.8 PMP in 2000 to 21.4 PMP in 2019), and 25 % in Asian or Pacific Islander (from 15 PMP in 2000 to 18.7 PMP in 2019), and decreased by 29 % in American Indian or Alaska Native (from 18 PMP in 2000 to 12.7 PMP in 2019). Conclusion: This is one of the largest subgroup-based racial population studies analyzing AML mortality trends. Between 2000 and 2019, the AML mortality was the highest in Whites and the lowest in American Indians or Alaska Natives. Furthermore, the American Indian or Alaska Native is the only race that showed a decline in the mortality trends. The mortality trends increased equally in White and Black American. The highest rate of increase was seen in the Asian or Pacific Islander. Multiple variables might contribute to the inequalities, including but not limited to the interaction of genetics, risk factors, response to therapy, socioeconomic status, and disparate access to health care and novel treatment regimens. Further studies are warranted to evaluate the causes of racial disparities and develop methods to reduce the gap.