Higher Age-adjusted Mortality Research Articles

Asian and Pacific Islander cancer mortality trends in the United States between 1999-2020.

e23307 Background: The Asian and Pacific Islander (API) population is the fastest growing in the United States, composing nearly 7% of the US population. Although cancer is the second leading cause of death overall in the U.S., it is the leading cause of death in the API population. Despite this, no study has assessed trends in cancer mortality in API individuals in the US. Our aim was to analyze differences and trends in API cancer mortality in the U.S. between 1999 to 2020. Methods: The CDC WONDER database was used to determine mortality statistics for patients, classified as non-Hispanic Asian or Pacific Islander, with cancer (ICD-10 codes C00-C97) as the underlying cause of death between 1999 and 2020. Age-adjusted mortality rates (AAMR) were calculated per 100,000 deaths, and were stratified by cancer type, sex, population density, U.S. census region, and age. Joinpoint regression software was used to identify temporal trends. Average annual percent change (APC) was considered statistically significant if p < 0.05. Results: Between 1999 and 2020, cancer accounted for 305,386 deaths in API individuals. During this period, there was a 30% decrease in mortality due cancer and a decrease in APC of -1.5% (p < 0.05). When stratified by cancer site, the largest decrease in APC was in stomach cancer at -3.7% (p < 0.05), and the largest increase was in uterine cancer at 2.6% (p < 0.05). In 1999, males experienced an overall cancer-related AAMR of 151, 48% higher than females at 103; however, by 2020 these differences reduced, with males having a cancer-related AAMR of 105.6 vs API females of 80.9, a 25% difference. Males experienced a larger decrease in APC (-1.8%, p < 0.05), compared with females (-1%, p < 0.05). Rural populations had the largest cancer-related AAMR (113.0) and largest drop in APC (-2%, p < 0.05), compared with urban groups with a cancer-related AAMR of 106.7 and APC drop (-1.3%, p < 0.05). The highest cancer related AAMRs was seen in lung cancer (24.3 in urban vs 25.4 in rural). Liver-cancer related AAMR was highest in urban populations at 10.4 and lowest in rural populations at 8.2. Western census regions had the highest AAMR at 113.7 with an APC decrease of –1.4% and Southern census regions had the lowest AAMR at 90.5 with an APC decrease of –1.2%. Adults aged > 65 experienced the highest cancer related AAMR at 588.2, and adults aged 25-44 demonstrated the lowest AAMR at 14.7. However, adults aged 25-44 experienced the largest decrease in APC at -2% (p < 0.05), compared with adults aged > 65 at -1.4% (p < 0.05). Conclusions: Our study identifies a significant decrease in cancer mortality in API individuals between 1999 and 2020. The largest decrease seen was in stomach cancer; however, uterine cancer mortality has increased. Notably, liver cancer mortality was higher in urban rather than rural groups. Further studies may examine differences amongst API and other racial groups, and potential sources for the disparities seen amongst API individuals.

Mortality of Laryngeal Cancer before and during the COVID-19 Pandemic

(1) Background: The interplay between coronavirus disease 2019 (COVID-19) and laryngeal cancer represents a substantial challenge for both patients and healthcare. To garner information on recent mortality data for laryngeal cancer, including during the COVID-19 pandemic, we analyzed real-world data from the US Centers for Disease Control and Prevention (CDC). (2) Methods: We searched the CDC WONDER online database 2018–2022 using the ICD-10 code for laryngeal cancer (C32; malignant neoplasm of the larynx). We also performed a sub-analysis between genders and across ten-year age groups. The data were analyzed with one-way analysis of variance (ANOVA) and Tukey’s post hoc test. (3) Results: The trend of age-adjusted mortality ×100,000 did not change significantly between the years 2018 and 2022 (p = 0.553). Males had higher age-adjusted mortality rates (M/F ratios between 4.6 and 5.0), but no significant variation was found in both genders (males: p = 0.676; females: p = 0.596). Although the mortality rate remained unchanged in people aged 35–84 years, the variation reached statistical significance in those aged 85 or older (p = 0.004), displaying a significant increase in 2021 compared to 2018 (p = 0.006) and 2019 (p = 0.039). (4) Conclusions: The impact of the COVID-19 pandemic on mortality for laryngeal cancer seems to be relatively modest in the general US population. Nevertheless, closer attention must be paid to older people, for whom the unfavorable consequences of misdiagnosis or mistreatment of this and other types of cancers can be exacerbated.

Disparities in Trend of Renal Cell Carcinoma Mortality in the United States.

Renal cell carcinoma (RCC) accounts for 90% of malignant neoplasms of the kidney. In this report, the CDC WONDER database was accessed to retrieve age-adjusted mortality data from 1999 to 2020 due to RCC, defined as ICD-10 Code: C64 Malignant neoplasm of kidney except renal pelvis, for various demographics to investigate trends and potential disparities. In 2020, the overall age-adjusted mortality rate (AAMR) due to RCC in the USA was 42.4 per 1,000,000. The average annual percent change (AAPC) for the USA from 1999 to 2020 was -0.6%. Notably, in 2020, men had a higher AAMR than women, 63.9 compared to 25.7, and a significant difference in AAPC trend was identified between men (-0.5%) and women (-1.0%). When investigating trends according to race in 2020, the Asian population displayed the lowest AAMR at 18.9. When determining AAPC from 1999 to 2020 according to race group, the American Indian group demonstrated the greatest decline in AAPC at -1.3%, followed by the Black (-1.2%) and White populations (-0.5%). The Asian population did not exhibit a significant AAPC. Moreover, the rates between these three groups were statistically significantly different- indicating disparities in trend based on race. This investigation assesses the AAMR for different demographic groups of the USA population to identify disparities and guide resource allocation strategies.

Trends and Disparities in Cardiovascular Death in Sarcoidosis: A Population-Based Retrospective Study in the United States From 1999 to 2020.

Despite significant cardiac involvement in sarcoidosis, real-world data on death due to cardiovascular disease among patients with sarcoidosis is not well established. We queried the Centers for Disease Control and Prevention's Wide-Ranging Online Data for Epidemiologic Research database for data on patients with sarcoidosis aged ≥25 years from 1999 to 2020. Diseases of the circulatory system except ischemic heart disease were listed as the underlying cause of death, and sarcoidosis was stated as a contributing cause of death. We calculated age-adjusted mortality rate (AAMR) per 1 million individuals and determined the trends over time by estimating the annual percentage change using the Joinpoint Regression Program. Subgroup analyses were performed on the basis of demographic and geographic factors. In the 22-year study period, 3301 cardiovascular deaths with comorbid sarcoidosis were identified. The AAMR from cardiovascular deaths with comorbid sarcoidosis increased from 0.53 (95% CI, 0.43-0.65) per 1 million individuals in 1999 to 0.87 (95% CI, 0.75-0.98) per 1 million individuals in 2020. Overall, women recorded a higher AAMR compared with men (0.77 [95% CI, 0.74-0.81] versus 0.58 [95% CI, 0.55-0.62]). People with Black ancestry had higher AAMR than people with White ancestry (3.23 [95% CI, 3.07-3.39] versus 0.39 [95% CI, 0.37-0.41]). A higher percentage of death was seen in the age groups of 55 to 64 years in men (23.11%) and women (21.81%), respectively. In terms of US census regions, the South region has the highest AAMR from cardiovascular deaths with comorbid sarcoidosis compared with other regions (0.78 [95% CI, 0.74-0.82]). The increase of AAMR from cardiovascular deaths with comorbid sarcoidosis and higher cardiovascular mortality rates among adults aged 55 to 64 years highlight the importance of early screening for cardiovascular diseases among patients with sarcoidosis.

How have US colorectal cancer mortality trends changed in the past 20 years?

In the last two decades, colorectal cancer (CRC) mortality has been decreasing in the United States. However, the mortality trends for the different subtypes of CRC, including different sides of colon, rectosigmoid, and rectal cancer remain unclear. We analyzed the mortality trends of different subtypes of CRC based on Centers for Disease Control and Prevention's Wide-Ranging Online Data for Epidemiologic Research data from 1999 to 2020. We calculated age-adjusted mortality rates (AAMR) per 100,000 individuals and examined the trends over time by estimating the average annual percent change (AAPC) using the Joinpoint Regression Program. Our study shows that the overall CRC rates decreased significantly from 26.42 to 15.98 per 100,000 individuals, with an AAPC of -2.41. However, the AAMR of rectosigmoid cancer increased significantly from 0.82 to 1.08 per 100,000 individuals, with the AAPC of +1.10. Men and Black individuals had the highest AAMRs respectively (23.90 vs. 26.93 per 100,000 individuals). The overall AAMR of CRC decreased for those aged ≥50 years but increased significantly from 1.02 to 1.58 per 100,000 individuals for those aged 15-49 years, with an AAPC of +0.75. Rural populations had a higher AAMR than the urban populations (22.40 vs. 19.60 per 100,000 individuals). Although overall CRC mortality declined, rising trends in young-onset CRC and rectosigmoid cancer warrant attention. Disparities persist in terms of sex, race, and geographic region, and urbanization level, emphasizing the need for targeted public health measures.

Abstract 2134: Disaggregating breast cancer mortality trends in Asian American women from 2005-2020

Abstract Background: Breast cancer (BC) is the second leading cause of death among women and has disproportionately higher rates of mortality in certain racial groups, including Asian Americans (AA). While differences in BC mortality between AA and other racial groups have been identified, few studies have disaggregated nationwide AA mortality data. Methods: Using National Vital Statistics System mortality data, BC-related deaths were analyzed among AA groups (Asian Indian, Chinese, Filipina, Japanese, Korean, Vietnamese), Native Hawiian and Pacific Islanders (NHPIs), and non-Hispanic Whites (NHWs) from 2005-2020. We calculated cancer proportional mortality ratios (PMRs), age-adjusted mortality rates (AAMRs), standard mortality ratios, and used JoinPoint regression for average annual percentage change (AAPC). Results: Among 13677 AA, 522 NHPI, 501282 NHW descendants, 14.3% cancer deaths were due to BC. PMRs increased for all racial groups except Filipina. AAMRs significantly decreased in NHWs (AAPC -1.61; CI -1.70 to -1.48) while significantly increasing for aggregate AAs (AAPC 0.45; CI 0.08 to 0.94). Among AAs, Filipinas had the highest AAMR. AAMRs significantly increased for Asian Indians (AAPC 2.05; CI 1.20 to 3.46), Filipinas (AAPC 0.61; CI 0.15 to 1.46), Koreans (AAPC 2.72; CI 1.57 to 4.65) and Vietnamese women (AAPC 3.63; CI 2.26 to 6.20), but significantly decreased for Japanese (AAPC -1.41; CI -2.22 to -0.53). Conclusions: We observed heterogenous and converging BC mortality trends across AA groups. These trends elucidate which populations within the broader AA group have disproportionately higher death rates and therefore should be targeted for BC prevention protocols (e.g., Asian Indian and Filipina). Identifying such trends can also help elucidate disparities in cancer care and the overall social determinants that affect women with BC. Understanding disaggregated trends can inform more inclusive screening practices and culturally tailored interventions and treatments to reduce BC deaths in vulnerable populations. Citation Format: Mia Marcotte, Yashi Chauhan, Vedha Penmetcha, Caroline Thompson, Candice Thompson, Malathi Srinivasan, Gloria Kim, Xinran Qi, Robert Huang, Adrian Bacong. Disaggregating breast cancer mortality trends in Asian American women from 2005-2020 [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 2134.

Trends in mortality related to venous thromboembolism in the European Union, 2012-2020.

We sought to assess the sex- and age-specific trends in venous thromboembolism (VTE) mortality in the 27 European Union Member States (EU-27) between years 2012 and 2020. Data on cause-specific deaths and population numbers by sex for each country of the EU-27 were retrieved through the publicly available European Statistical Office (EUROSTAT) dataset for the years 2012-2020. VTE-related deaths were ascertained when ICD-10 codes I26, I80, and I82.9 were listed as the primary cause of death in the medical death certificate. To calculate annual trends, we assessed the average annual percent change (AAPC) with relative 95% confidence intervals (CIs) using Joinpoint regression. During the study period, 96,037 (55,278 males and 40,759 females) died for VTE. The age-adjusted mortality rate (AAMR) linearly declined from 2.86 (95% CI 2.84-2.90) deaths per 100,000 individuals in 2012 to 2.53 (95% CI 2.50-2.56) deaths per 100,000 population in 2020 [AAPC: - 2.1% (95% CI - 3.6 to - 0.6), p = 0.001] without differences between sexes (p = 0.60). The higher AAMR was observed in some eastern European countries such as Bulgaria, Czech Republic, and Lithuania. On the contrary, the lower AAMR was mainly clustered in the Mediterranean area (Italy, Spain, and Cyprus). Over the last decade, the age-adjusted VTE-related mortality has been continuously declining in most of the in EU-27 Member States. However, some disparities still exist between western and eastern European countries.

Gender, Racial, and Geographical Disparities in Malignant Brain Tumor Mortality in the USA

Introduction: Malignant brain tumors are malignancies which are known for their low survival rates. Despite advancements in treatments in the last decade, the disparities in malignant brain cancer mortality among the US population remain unclear. Methods: We analyzed death certificate data from the US CDC WONDER from 1999 to 2020 to determine the longitudinal trends of malignant brain tumor mortality. Malignant brain tumor (ICD-10 C71.0–71.9) was listed as the underlying cause of death. Age-adjusted mortality rates (AAMRs) per 100,000 individuals were calculated by standardizing the AAMR to the year 2000 US population. Results: From 1999 to 2020, there were 306,375 deaths due to malignant brain tumors. The AAMR decreased from 5.57 (95% CI, 5.47–5.67) per 100,000 individuals in 1999 to 5.40 (95% CI, 5.31–5.48) per 100,000 individuals in 2020, with an annual percent decrease of −0.05 (95% CI, −0.22, 0.12). Whites had the highest AAMR (6.05 [95% CI, 6.02–6.07] per 100,000 individuals), followed by Hispanics (3.70 [95% CI, 3.64–3.76]) per 100,000 individuals, blacks (3.09 [95% CI, 3.04–3.14] per 100,000 individuals), American Indians (2.82 [95% CI, 2.64–3.00] per 100,000 individuals), and Asians (2.44 [95% CI, 2.38–2.50] per 100,000 individuals). The highest AAMRs were reported in the Midwest region (5.58 [95% CI, 5.54–5.62] per 100,000 individuals) and the rural regions (5.66 [95% CI, 5.61–5.71] per 100,000 individuals). Conclusions: Our study highlights the mortality disparity among different races, geographic regions, and urbanization levels. The findings underscore the importance of addressing the disparities in malignant brain tumors that existed among males, white individuals, and rural populations.

Epithelial ovarian cancer survival by race and ethnicity in an equal-access healthcare population

BackgroundPrevious studies in the general population observed that compared with non-Hispanic White women, Pacific Islander and Black women have higher age-adjusted mortality rates from epithelial ovarian cancer (EOC), while Asian American patients have lower mortality. We investigated whether race and ethnicity is associated with differences in EOC survival in a United States Military population where patients have equal access to healthcare.MethodsThis retrospective study included women diagnosed with EOC between 2001 and 2018 among Department of Defense beneficiaries. Hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated using Cox proportional hazards regression models adjusting for age and year of diagnosis, histology and stage.ResultsIn our study population of 1230 invasive EOC cases (558 non-Hispanic White, 74 non-Hispanic Black, 73 Asian, 30 Pacific Islander and 36 Hispanic cases), 63% of the women died (all-cause death) after a mean = 4.8 years (SD = 4.1) of follow-up following diagnosis. Compared with non-Hispanic White cases, Asian cases had better overall survival, HR = 0.76 (95% CI = 0.58–0.98), whereas there were no differences in survival for other racial and ethnic groups.ConclusionsThese findings highlight the need to investigate how differences in access to healthcare may influence observed racial and ethnic disparities for EOC.

Trends and Disparities of Chronic Lymphocytic Leukemia Mortality in the United States from 1999 to 2020

Background Chronic lymphocytic leukemia (CLL) is the most common chronic leukemia in the United States (US). In the last decade, the treatment landscape of CLL has significantly evolved, and the clinical outcomes improved. However, data on the mortality trends of CLL is not well-established. Objective This study aimed to analyze the trends in mortality rates due to CLL and to assess the disparities in the mortality rates among different sex, ages, races, and geographic locations. Methods We obtained death certificate data for CLL mortality among patients aged 35 years and above from the Centers for Disease Control and Prevention's Wide-Ranging Online Data for Epidemiologic Research (CDC WONDER) database. CLL (International Classification of Diseases, Tenth Revision [ICD-10] C91.1) was listed as the underlying cause of death. Age-adjusted mortality rates (AAMRs) per 100,000 individuals were calculated, and the trends over time were analyzed by measuring the average annual percent change (AAPC) using the Joinpoint Regression Program. Subgroup analyses were conducted by sex, race, age, census region, and urbanization level. Results In the 22-year study period from 1999 to 2020, 97,186 deaths attributed to CLL were reported in the US. The CLL mortality rate decreased from 3.23 (95% CI, 3.13 - 3.32) per 100,000 individuals in 1999 to 2.05 (95% CI, 1.99 - 2.11) per 100,000 individuals in 2020 with the AAPC of -2.09 (95% CI, -2.69, -1.49). The highest AAMR was observed among non-Hispanic White men (4.14 [95% CI, 4.10 - 4.17] per 100,000 individuals), followed by non-Hispanic Black men (3.48 [95% CI, 3.37 - 3.59] per 100,000 individuals), non-Hispanic White women (1.88 [95% CI, 1.86 - 1.90] per 100,000 individuals), and non-Hispanic Black women (1.61 [95% CI, 1.55 - 1.67] per 100,000 individuals). Figure 1 shows the trends of AAMR in non-Hispanic White and non-Hispanic Black men and women over the years. Black individuals had the greatest decline in AAMR over the years with the AAPC of -2.87 (95% CI, -3.31, -2.42) whereas Hispanic individuals had the smallest decline in AAMR over the years with the AAPC of -1.50 (95% CI, -2.30, -0.69). Patients aged 75-84 years had the highest AAMR at 0.99 (95% CI, 0.98 - 1.00) per 100,000 individuals among different age groups. The greatest decline in AAMR was reported among patients aged between 45-54 years with the AAPC of -4.91 (95% CI, -6.16, -3.65). Those who lived in the Midwest region had the highest AAMR (2.93 [95% CI, 2.89 - 2.97] per 100,000 individuals), followed by the Northeast region (2.52 [95% CI, 2.49 - 2.56] per 100,000 individuals), the South region (2.48 [95% CI, 2.46 - 2.51] per 100,000 individuals), and the West region (2.38 [95% CI, 2.34 - 2.41] per 100,000 individuals). The greatest decline in AAMR over the years was observed among those who lived in the South region with the AAPC of -2.42 (95% CI, -2.68, -2.16). A higher AAMR was observed in the rural population (2.87 [95% CI, 2.83 - 2.91] per 100,000 individuals) in comparison to the urban population (2.53 [95% CI, 2.51 - 2.55] per 100,000 individuals). Conclusion CLL mortality has declined over the last two decades, likely due to the introduction of novel therapies. However, disparities among different sex, races, ages, geographic regions, and urbanization levels still exist. Our study underscores the importance of addressing these disparities and improving outcomes for susceptible individuals affected by CLL.

Unveiling Alarming Trends: Worsening All Cause Mortality in US Adults over 25 with Amyloid 1999-2020 Analysis

Introduction: Amyloidosis is a collective term for conditions with an abnormal extracellular deposition of amyloid protein. Amyloidosis can be classified based on the location of deposition (localized vs systemic) and by the different subtypes of proteins which are created as a result of a variety of diseases (plasma cell dyscrasias, chronic inflammation, nephrotic syndrome, genetic). Depending on the affected organs, amyloidosis can present with, not limited to, hepatomegaly, renal impairment, nerve conduction impairment, cardiac conduction abnormalities, restrictive cardiomyopathy, and multiorgan failure. In the last century there has been an increase in innovations leading to a better understanding of the pathology, diagnostic tests, staging, and treatment options for amyloidosis. Our study aims to compare all cause mortality trends in adults over 25 years old diagnosed with amyloidosis in the United States. Methods: The national mortality trends from 1999 to 2020 for all subtypes of amyloid were analyzed from the CDC WONDER database. The data was extracted using ICD codes E85 (Amyloidosis) with subgroups E85.0 (Non-neuropathic heredofamilial amyloidosis), E85.3 (Secondary systemic amyloidosis), E85.4 (Organ-limited amyloidosis), E85.8 (Other amyloidosis), and E85.9 (Amyloidosis, unspecified. Data was stratified for age groups above 25 years old. Age-adjusted mortality rates (AAMRs) were calculated per 100,000 people and death certificate data was stratified by reported sex, race/ethnicity, and US census region. Results: Between 1999 and 2020 there were 40,015 deaths from amyloid. Our analysis revealed that all-cause AAMR per 100,000 people with amyloid showed an increasing trend between 1999 to 2020 (Figure 1). Subgroup analysis on race/ethnicity revealed the AAMR for the Black population has been consistently higher to other groups (Table 1). On average, from 1999 to 2020, the Black population had the highest AAMR (1.52 AAMR) followed by the White population (0.78 AAMR), Hispanic (0.55 AAMR), and Asian (0.5 AAMR). Further subgroup analysis revealed men have a higher AAMR (1.9 AAMR, 2020) compared to women (0.8 AAMR, 2020). Overall there are similar census region trends of all mortality in Amyloid: North (1.5 AAMR, 2020), Midwest (1.5 AAMR, 2020), South (1.0, AAMR, 2020) and West (1.3 AAMR, 2020). Conclusion: Due to advancement in technology, amyloid diseases are becoming more widely recognized and increasingly diagnosed. Unfortunately, treatment of amyloidosis remains limited to early diagnosis and treatment of the underlying condition. This includes modalities such as chemotherapy and stem cell transplantation for plasma cell dysplasias and TTR stabilizers for hereditary amyloidosis. These trends in increase in AAMR likely reflect the increased awareness/diagnostics of amyloid disease and complications. The African American population may have higher AAMR due to socioeconomic and environmental factors, health disparities, and research bias. We also suspect men have a higher ATTR than women as it has been reported that ATTR and AL Amyloidosis tends to occur more frequently in men than women and is associated with more severe disease (Kroi et al., 2020, Desport et al., 2012). Further research is necessary to expand on the disparities seen with the ultimate goal of providing targeted therapies to reverse this downward trend.

Demographic and Regional Trends in Chronic Lymphocytic Lymphoma in Older Adults in the United States between 1999 and 2020

Introduction: Chronic lymphocytic leukemia (CLL) accounts for the highest number of leukemia diagnoses in adults over 19 and nearly 25% of new adult leukemia cases. CLL commonly affects older adults with a median age of 70 at diagnosis. Although the 5-year survival rate of CLL is high at 88%, there are disparities among various groups within the United States (U.S.) with marginalized groups experiencing lower survival than their counterparts. Currently, no study has assessed geographic and demographic trends in CLL mortality in older adults (65+) in the U.S. Our aim was to analyze demographic differences and trends in CLL mortality in older adults (65+) within the U.S. between 1999 to 2020. Methods: The CDC (Centers for Disease Control) Wonder database was used to determine mortality statistics for patients, 65 years or older, with an underlying cause of death from CLL (ICD-10 code C91.1) between 1999 and 2020. Age-adjusted mortality rates (AAMR) were calculated per 100,000 deaths. The AAMR was calculated by demographic variables such as race (Hispanic, Non-Hispanic Black, Non-Hispanic White), population density (Urban, Suburban, Rural), sex, state, and U.S. census region. Joinpoint regression software was used to identify temporal trends. Average annual percent change (APC) was considered statistically significant if p< 0.05. Results: Between 1999 and 2020, CLL accounted for 85,371 deaths in adults 65 years or older. During this time, the overall AAMR decreased by 30% from 11.2 to 7.8 with an APC of -1.7% (p<0.05). In 1999, men had an AAMR of 16.1, nearly double the female AAMR of 8.1. By 2020, both groups experienced a drop in AAMR with men at 11.4 and females at 5.1. Both groups experienced a significant drop in overall APC with a drop of -1.7 for men and -2.1 for females. Non-Hispanic Whites had the highest AAMR at 11.9 and had a decrease in APC at -1.4 (p<0.05). Non-Hispanic Blacks had an AAMR high of 9.6 and had the highest decrease in APC at -2.4 (p<0.05). Hispanic individuals had an AAMR high of 4.4 and had the lowest decrease in APC at -1.3 (p<0.05). Analysis by population density revealed the highest decrease in APC occurring in urban populations at -2.3 (p<0.05), and the lowest decrease in rural populations at -1.2. All census regions (Northeast, Midwest, South, and West) had significant drops in APC with the South having the largest decrease in APC at -2.1 (p<0.05) and the Northeast having the lowest drop in APC at -1.5 (p<0.05). States in the 90th percentile of mortality included Iowa, North Dakota, and South Dakota, whereas Hawaii, Nevada, and New Mexico were in the 10th percentile of mortality. Conclusions: Although the mortality rate for CLL in the U.S. has been decreasing since 1999, there are differences in the rate of decrease apparent amongst various demographic groups. This may be due to several factors, including longer travel times to see oncologists in rural areas or lack of access to newer treatments for these patients. Given that the typical presentation for CLL is asymptomatic and that there are few identifiable risk factors for CLL it has made identification of vulnerable patients challenging. However, demographic background may help to identify potential patients at risk for developing and experiencing higher mortality rates due to CLL.

1524. Racial and Gender Disparities in HIV Mortality: A population-based Retrospective Study in the United States from 1999 to 2020

Abstract Background Human Immunodeficiency Virus (HIV) has been historically associated with high mortality however, rates have declined with expanded access to antiretroviral therapy. It is important to identify and dissect inequities that contribute to mortality rates in individuals with HIV, which may help inform targeted interventions to improve treatment access in future decades. This study sought to determine the longitudinal trends in mortality attributed to HIV disease by race and sex. Methods We queried the Centers for Disease Control and Prevention's Wide-Ranging Online Data for Epidemiologic Research (CDC WONDER) database and performed serial cross-sectional analyses of national death certificate data for HIV-related mortality. HIV diseases (ICD-10 B20-B24, O98.7, R75) were listed as the underlying cause of death. We calculated age-adjusted mortality rates (AAMR) per 1,000,000 individuals and determined the trends over time by using the Joinpoint Regression Program. Subgroup analyses were performed by sex and race.Figure 1Demonstrates Age-Adjusted HIV Mortality Rate per 100,000 Results In the 22-year study period, 210 921 HIV-related mortality in the United States were identified between 1999 and 2020. The AAMR from HIV-related mortality decreased significantly from 5.32 per 1,000,000 individuals in 1999 to 1.40 per 1,000,000 individuals in 2020 (p< 0.01). Overall, men recorded a higher AAMR compared to women (4.66 vs. 1.65 per 1,000,000 individuals, p< 0.01). African American individuals had the highest AAMRs (13.46 per 1,000,000 individuals) compared to White, American Indian, and Asian individuals (1.70 vs 1.65 vs 0.47 per 1,000,000 individuals). Similar decreasing trends were seen in all racial groups: African American men from 36.12 to 8.11 per 1,000,000 individuals, African American women from 13.13 to 3.54 per 1,000,000 individuals, White men from 4.91 to 1.36 per 1,000,000 individuals, and White women from 1.00 to 0.27 per 1,000,000 individuals. Conclusion The AAMR from HIV-related mortality has decreased significantly over the last two decades with significant racial and gender disparities. Men and African American individuals have higher AAMR from HIV-related mortality. This highlights the effectiveness of antiretroviral medications and emphasizes the need to improve the healthcare access among those underserved population. Disclosures Jihad Slim, MD, FACP, ViiV Healthcare: Advisor/Consultant|ViiV Healthcare: Grant/Research Support

Abstract 13624: Worrisome Atrial Fibrillation-Related Mortality Trends in Older Adults From 1999-2019

Introduction: The U.S. population is aging with concurrent increases in atrial fibrillation (AF) burden. However, AF-related mortality trends among adult’s ≥75 years have not been investigated. The purpose of this study was to assess the trends and regional differences in AF-related mortality among older adults in the United States. Methods: Death certificates from the CDC WONDER (Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research) database were examined from 1999 to 2019 for AF-related mortality in adult’s ≥75 years of age. Age-adjusted mortality rates (AAMRs) per 100,000 persons was calculated and stratified by year, sex, race/ethnicity, and geographic region. Results: Between 1999 and 2019, 323,349 AF-related primary deaths occurred among adult’s ≥75 years. The AAMR more than doubled from 44.8 (95% CI, 43.8 to 45.8) in 1999 to 91.7 in 2019 (95% CI: 87.2 to 89.6)). Women had consistently higher AAMR than men from 1999 (AAMR women: 45.8 vs men: 42.3) to 2019 (AAMR women: 93.2 vs men: 88.4). White adults had the highest overall AAMR (77.5), followed by NH American Indian/Alaska Native (41.6), NH Black (41.3) and NH Asian or Pacific Islander adults (36.6). AAMR also varied substantially by region (overall AAMR: Midwest 77.6; West: 75.0; Northeast: 71.6; and South: 69.7). States in the top 90th percentile of AF-related AAMR were Oregon, Idaho and Utah, which had approximately double the AAMRs compared with states that fell into the lower 10th percentile such as South Dakota and Florida. Conclusions: AF-related mortality in U.S. adult’s ≥75 years has continuously increased since 1999. The highest AAMRs were observed among White adults and women, and among patients living in the Midwest and western regions of the United States. Targeted strategies are needed to prevent and treat AF among older adults to curb increasing levels of AF-related mortality.

Abstract 13023: Trends and Disparities in Cardiovascular Deaths in Non-Hodgkin Lymphoma: A Population-Based Retrospective Study in the United States From 1999 to 2020

Background: Non-Hodgkin lymphoma (NHL) survivors are at increased risks of cardiovascular disease related death (CVD) compared to the general population. Objective: This study sought to determine the longitudinal trends in mortality attributed to CVD with comorbid NHL by race, sex, and geographic location. Methods: We queried the Centers for Disease Control and Prevention's Wide-Ranging Online Data for Epidemiologic Research database among patients aged 18 and above from 1999 to 2020. Patients were identified when the primary causes of death were ischemic heart diseases (ICD 10 I20-I25), cerebrovascular diseases (I60-I69), or hypertensive disease (I10-I15), and NHL (C82-C85) was a contributing cause of death. We calculated age-adjusted mortality rates (AAMRs) per 1,000,000 individuals and determined the trends over time by estimating the annual percent change using the Joinpoint regression program. Results: In the 22-year study period, a total of 22,778 CVD with comorbid NHL were identified. Overall, there was a significant decrease in annual trends for the AAMRs of CVD from 6.91 per 1,000,000 individuals in 1999 to 4.12 per 1,000,000 individuals in 2020 (p<0.05), with an annual percent decrease of 3.3. Overall, men recorded a higher AAMRs compared to women (6.76 vs 3.45, p<0.05). When stratified by race, White individuals had the highest AAMRs (5.07), while the AAMRs for American African, Asian, American Indian individuals were 3.01, 2.77, and 2.48 per 1,000,000 individuals respectively. The AAMRs were higher in the rural region than in the urban region (4.97 vs 4.78, p<0.05). Among all consensus regions, South region had the highest AAMRs. Conclusion: In conclusion, our study revealed a significant decrease in cardiovascular disease related deaths with comorbid NHL over the past two decades. It provides valuable insights into the effectiveness of management of comorbid CVD or CVD risk factors in patients with NHL.

Abstract 14874: Trends and Disparities in Cardiovascular Death in Colorectal Cancer: A Population-Based Retrospective Study in the United States From 1999 to 2020

Background: Overlap between cardiovascular diseases and colorectal cancer(CRC) has become more prominent with enhanced life expectancy. The data on cardiovascular deaths (CVDs) among those patients is not well-established. Objective: This study sought to determine the longitudinal trends in mortality attributed to CVDs with comorbid CRC by race, sex, and region. Methods: We queried the Centers for Disease Control and Prevention's Wide-Ranging Online Data for Epidemiologic Research database and performed serial cross-sectional analyses of national death certificate data for CVDs with comorbid CRC among patients aged 18 and above. Diseases of the circulatory system were listed as the underlying cause of death, and colorectal cancer as contributing cause of death. We calculated age-adjusted mortality rates (AAMR) per 1,000,000 individuals and determined the trends by using the Joinpoint Regression Program. Results: In the 22-year study period, 77,094 CVDs with comorbid CRC were identified between 1999 and 2020. The AAMR from CVDs with comorbid CRC decreased significantly from 29.73 per 1,000,000 individuals in 1999 to 9.65 per 1,000,000 individuals in 2020 (p<0.05). The most common CVDs reported were ischemic heart disease (56%) and cerebrovascular disease (14%). Males had a higher AAMR compared to females (21.51 vs 12.53 per 1,000,000 individuals, p<0.05). African Americans had the highest AAMR (18.12 per 1,000,000 individuals), while the AAMRs for White populations, American Indian, and Asian populations were 16.28, 9.09, and 9.06 respectively. Rural areas had a higher AAMR than urban areas (18.25 vs 15.76 per 1,000,000 individuals, p<0.05). Conclusion: The CVDs in patients with CRC have decreased significantly over the past two decades, with disparities seen in African Americans and rural regions. This highlights the importance of early screening among high-risk populations, and the importance of improving healthcare access in underserved populations.

Mortality Trends and Causes of Death in Individuals with Thalassemia: A Population-Based Retrospective Study in the United States from 1999 to 2020

Background Thalassemia is a hereditary hemoglobinopathy that results in ineffective erythropoiesis. Patients with thalassemia have varying degrees of severity ranging from mild anemia to severe complications due to iron overload. Despite its clinical significance, the study on the mortality rate among patients with thalassemia in the United States (US) remains scarce. Objective This study aimed to analyze the trends in thalassemia-related mortality rate and the underlying causes of death among individuals with thalassemia. Methods We queried the Centers for Disease Control and Prevention's Wide-Ranging Online Data for Epidemiologic Research (CDC WONDER) database and performed serial cross-sectional analyses of national death certificate data for thalassemia-related mortality among patients of all ages. Thalassemia (International Classification of Diseases, Tenth Revision [ICD-10] D56) was listed as the contributing cause of death. We calculated age-adjusted mortality rates (AAMRs) per 1,000,000 individuals and examined the trends over time by estimating the average annual percent change (AAPC) using the Joinpoint Regression Program. Subgroup analyses were performed by sex, age, race, census region, and urbanization level. Results From 1999 to 2020, there were 2,797 deaths related to thalassemia. Among these deaths, beta thalassemia accounted for 24.87%, alpha thalassemia accounted for 6.00%, thalassemia trait accounted for 2.52%, dominant thalassemia, hemoglobin C thalassemia, mixed thalassemia, or thalassemia with other hemoglobinopathies accounted for 1.92%, and unspecified thalassemia accounted for 64.37%. The baseline demographics of patients who met the inclusion criteria are shown in Table 1. Thalassemia-related mortality rate showed an overall decline in trend from 0.50 (95% CI, 0.41 - 0.58) per 1,000,000 individuals in 1999 to 0.34 (95% CI, 0.28 - 0.40) per 1,000,000 individuals in 2019, but increased to 0.48 (95% CI, 0.41 - 0.55) per 1,000,000 individuals in 2020 (Figure 1). The highest AAMR was observed among Asians (1.34 [95% CI, 1.20 - 1.47] per 1,000,000 individuals), followed by non-Hispanic Blacks (0.65 [95% CI, 0.59 - 0.71] per 1,000,000 individuals), non-Hispanic Whites (0.32 [95% CI, 0.30 - 0.33] per 1,000,000 individuals), and Hispanics (0.11 [95% CI, 0.08 - 0.14] per 1,000,000 individuals). The most common underlying causes of death among individuals with thalassemia were cardiovascular causes (26.0%), followed by hematological causes (20.7%), malignancy (17.8%), endocrine disorders (6.3%), respiratory causes (6.2%), disorders of the nervous system (5.0%), gastrointestinal diseases (4.9%), psychiatric disorders (3.3%), infection (3.0%), and other causes (6.7%). Among the cardiovascular causes, ischemic heart disease (11.0%) was the most common cause, followed by hypertensive disease (3.0%), cerebrovascular disease (1.7%), aortic valve disease (1.1%), cardiomyopathy (0.79%), and atrial fibrillation and flutter (0.79%). The urban population had a higher AAMR compared to the rural population (0.43 [95% CI, 0.41 - 0.45] per 1,000,000 individuals vs. 0.29 [95% CI, 0.26 - 0.32] per 1,000,000 individuals). Nevertheless, the rural areas exhibited an increasing trend in the AAMR (+6.90%) while the urban areas exhibited a decreasing trend in the AAMR (-11.36%) during the study period. Conclusion While there has been an overall decline in the thalassemia-related mortality rate, variations exist among different races, geographic regions, and urbanization levels. Our study emphasizes the need for targeted interventions to address these disparities.

Examining Trends in Kidney Cancer Mortality by Gender and Race in the United States: A 20-Year Analysis

Abstract Background Kidney cancer (KC) is a significant contributor to cancer mortality worldwide, with gender, racial, and ethnic disparities impacting outcomes. While previous studies have investigated the outcomes of diverse patient populations, gaps in knowledge remain. The incidence of KC has been rising steadily, and it is essential to understand the patterns of mortality to identify and address disparities in healthcare. Therefore, this study aimed to investigate trends in age-adjusted mortality rates (ASMR) by gender, race, and ethnicity in the US at national levels. Methods The Center for Disease Control Wonder database was used to extract national KC mortality data (ICD-10 C64) from 1999-2020. ASMR and 95% confidence intervals (CI) were extracted based on gender and race reported per 100,000 population. Absolute percentage changes were calculated. Joinpoint Command Line Version 4.5.0.1 was used to apply a Joinpoint regression analysis and calculate Average Annual Percentage Change (AAPC). IRB approval was not needed as CDC is an open-source database with de-identified information. Results Over twenty years, 284,224 KC deaths were reported, with an overall decrease in ASMR in recent years. Males had significantly higher ASMR throughout the study period, with a lower decrease than females. Female mortality rates for all racial and ethnic groups declined over the study period, with the largest decrease observed in American Indian/Alaskan Native females (-34.3%). However, American Indian/Alaskan Native females still had the highest mortality rates in 2020. Asian females had the lowest mortality rates throughout the study period, but they only decreased slightly (-8.3%). African American and white females had similar mortality rates that decreased by 25% and 22.2%, respectively. Among males, there was a general decline in mortality rates across all racial and ethnic groups, with the largest decrease observed in American Indian/Alaskan Native males (-44.3%). Despite having lower mortality rates than most other groups, White males had the highest age-adjusted mortality rate (ASMR) of 5.7 in 2020 due to the lack of significant decline. When considering the average annual percentage change (AAPC) over the entire period, the decline in mortality rate was statistically significant for all groups except Asian females. The AAPC ranged from -2.1% for American Indian/Alaskan Native females to -0.4% for Asian females. The steepest decline was observed in American Indian/Alaskan Native males (-2.1%), followed by American Indian/Alaskan Native females (-1.8%) and African American females (-1.7%). Conclusions In conclusion, our study highlights significant gender, racial, and ethnic disparities in kidney cancer mortality rates in the US. Our study underscores the importance of targeted interventions to reduce mortality rates among American Indian/Alaskan Native populations, who consistently had the highest mortality rates in kidney cancer throughout the study period. Additionally, our findings highlight the need for continued attention to male mortality rates at the gender level. The results of this study can inform healthcare policies and practices that aim to address the disparities in kidney cancer mortality rates and ultimately improve the health outcomes of all populations. CDMRP DOD Funding: no

Trends in Colorectal Cancer Mortality in the United States, 1999 - 2020.

The United States faces a significant public health issue with colorectal cancer (CRC), which remains the third leading cause of cancer-related fatalities despite early diagnosis and treatment progress. This investigation utilized death certificate data from the Centers for Disease Control and Prevention Wide-Ranging OnLine Data for Epidemiologic Research (CDC WONDER) database to investigate trends in CRC mortality and location of death from 1999 to 2020. Additionally, the study utilized the annual percent change (APC) to estimate the average annual rate of change over the specific time period for the given health outcome. Incorporating the location of death in this study served the purpose of identifying patterns related to CRC and offering valuable insights into the specific locations where deaths occurred. Between 1999 and 2020, there were 1,166,158 CRC-related deaths. The age-adjusted mortality rates (AAMRs) for CRC consistently declined from 20.7 in 1999 to 12.5 in 2020. Men had higher AAMR (18.8) than women (13.4) throughout the study. Black or African American patients had the highest AAMR (21.1), followed by White (15.4), Hispanic/Latino (11.8), American Indian or Alaska native (11.4), and Asian or Pacific Islanders (10.2). The location of death varied, with 41.99% at home, 28.16% in medical facilities, 16.6% in nursing homes/long-term care facilities, 7.43% in hospices, and 5.80% at other/unknown places. There has been an overall improvement in AAMR among most ethnic groups, but an increase in AAMR has been observed among white individuals below the age of 55. Notably, over one-quarter of CRC-related deaths occur in medical facilities.

Trends in Pulmonary Embolism Deaths Among Young Adults Aged 25 to 44 Years in the United States, 1999 to 2019

A concerning increase in mortality from acute pulmonary embolism (PE) in young adults in the United States has been reported. We extracted PE-related mortality rates (number of deaths per US population) from the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research database from 1999 to 2019, focusing on subjects aged 25 to 44years. Age-adjusted mortality rates (AAMRs) were assessed using the Joinpoint regression modeling and expressed as the estimated average annual percentage change (AAPC) with relative 95% confidence intervals (95% CIs) and stratified by urbanization, gender, age, and race. Between 1999 and 2019, the AAMR from acute PE in US adults aged 25 to 44years linearly increased without any difference between genders (AAPC +1.5%, 95% CI 1.2 to 1.8, p <0.001). AAMR increase was more pronounced in American-Indians/Alaska Natives and in Asian/Pacific Islanders (AAPC +2.5%, 95% CI 1.6 to 3.4, p <0.001), Whites (AAPC +1.7%, 95% CI 1.4 to 2.0, p <0.001), Latinx/Hispanic patients (AAPC +1.7%, 95% CI 0.6 to 3.0, p=0.003), and residents of rural areas (AAPC +2.4%, 95% CI 1.9 to 2.8, p <0.001). A higher AAMR (4.02 per 100,000 residents, 95% CI 3.90 to 4.15) and absolute number of PE-related deaths were observed in the South. PE-related mortality in adults aged 25 to 44years has increased over the last 2 decades in the United States. Stratification by race, ethnicity, urbanization, and census region showed ethnoracial and regional disparities that will require further evaluation and remedy.