Race-Specific Mortality from Multiple Myeloma: A CDC Database Population Study in the United States between 2000 and 2020

Background:

Multiple myeloma is the second most prevalent hematologic cancer, following lymphoma, with a median overall survival of 5 to 10 years. Multiple myeloma prognosis has markedly changed over time. Despite that, there are significant racial inequalities in the incidence and overall survival of all different types and stages of the disease. Interestingly, it is twice as prevalent and fatal among African-Americans as White. In the lack of studies examining racial disparities in racial subgroups, we conducted a retrospective study to assess mortality trends across all racial groups in the United States between 2000 and 2020.

Method:

We performed a retrospective study utilizing the Centers for Disease Control and Prevention (CDC) database. Employing the multiple cause of death database (ICD-10 revision codes), we identified all patients who died of Multiple Myeloma (C90.0.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 2020 in the United States regardless of Hispanic origin 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.

Result:

Between 2000 and 2020, a total of 237,496 multiple myeloma deaths were identified in all races, with an overall age-adjusted mortality of 33.4 PMP. We identified a total of 189,964 deaths, 41,823 deaths, 4,558 deaths, and 1,151 deaths in the White, Black, Asian or Pacific Islander, and American Indian or Alaska Native populations respectively. The overall age-adjusted mortalities were 31.1 PMP, 62.1 PMP, 16 PMP, and 22.7 PMP in the White, Black, Asian or Pacific Islander, and American Indian or Alaska Native populations respectively. Furthermore, over the 20 years, the age-adjusted mortality decreased by 26 % in Black (from 74.5 PMP in 2000 to 54.8 PMP in 2020), 22 % in White (from 35.2 PMP in 2000 to 27.5 PMP in 2020), 12 % in Asian or Pacific Islander (from 16.3 PMP in 2000 to 14.4 PMP in 2020), and 52 % in American Indian or Alaska Native (from 28.8 PMP in 2000 to 13.9 PMP in 2020).

Conclusion:

This comprehensive population-based study demonstrates that there are racial disparities in multiple myeloma mortality. Within the past two decades, the mortality was highest among African Americans and lowest among Asians and Pacific Islanders. Moreover, all racial groups had a decrease in mortality trends. American Indian Alaskans had the highest rate of decrease, which was double that of blacks. Multiple factors can contribute to the disparities including but not limited to the interplay between disease biology, risk factors, treatment response, and unequal access to innovative therapies. Further studies are needed to investigate the causes of the racial disparities and identify strategies to minimize the racial gap.