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5103 Trends and Disparities in Acute Lymphoblastic Leukemia-Related Mortality in the United States from 1999 to 2020: Insights from the CDC Wonder Database

Program: Oral and Poster Abstracts
Session: 906. Outcomes Research: Lymphoid Malignancies Excluding Plasma Cell Disorders: Poster III
Hematology Disease Topics & Pathways:
Lymphoid Leukemias, ALL, Diseases, Lymphoid Malignancies
Monday, December 9, 2024, 6:00 PM-8:00 PM

Moazzam Shahzad, MD1, Eeman Ahmad2*, Shahzaib Ahmed2*, Umar Akram3*, Shoaib Ahmad4*, Muhammad Kashif Amin, MD5*, Fatima Tuz Zahra, MBBS6, Muhammad Umair Mushtaq5,7 and Michael V. Jaglal, MD8

1Department of Oncological Sciences, H. Lee Moffitt Cancer Center, University of South Florida, Tampa, FL
2Fatima Memorial Hospital College of Medicine and Dentistry, Lahore, Pakistan
3Allama Iqbal Medical College, Lahore, Pakistan
4Punjab Medical College, Faisalabad, Pakistan
5Division of Hematologic Malignancies & Cellular Therapeutics, University of Kansas Medical Center, Kansas City, KS
6H. Lee Moffitt Cancer Center, University of South Florida, Tampa, FL
7Mikael Rayaan Foundation Global Health Consortium, Kansas City, KS
8Department of Hematology/Oncology, Moffitt Cancer Center, Tampa, FL

Introduction

Acute lymphoblastic leukemia (ALL) has a bimodal distribution. The risk of developing ALL is higher in pediatric populations under 5 years, which declines until the mid-twenties, and then rises again after the fifties. However, the mortality is higher in the adult population compared to pediatrics. Therefore, it is important to identify and analyze trends in deaths related to ALL.

Methods

Age-adjusted mortality rates (AAMR) per 100,000 population from 1999 to 2020 were extracted from the CDC Wide-ranging ONline Data for Epidemiologic Research (WONDER) database. ICD-10 code C91.0 was used to assign ALL as the contributing cause of death. AAMRs were stratified by year, gender, race, and geographical distribution. Annual percentage change (APC) in AAMR was calculated via Joinpoint regression using the Joinpoint Regression Program (V 5.1.0, National Cancer Institute).

Results

A total of 35,056 ALL-related deaths occurred from 1999 to 2020. The AAMR decreased from 1999 to 2020 (APC: -0.65). The AAMR remained higher in men (overall AAMR: 0.59) than in women (overall AAMR: 0.43) throughout the study period, and the AAMRs for both decreased (APC men: -0.75; women: -0.56). Upon stratification by race, several data points for non-Hispanic (NH) American Indian or Alaska Natives were found to be unreliable. The highest AAMR was observed in Hispanics or Latinos (0.75), although this remained largely unvaried (APC: -0.11). The AAMR for NH Whites (0.47) was higher than that of NH Black or African Americans (0.37) and decreased for both from 1999 to 2020 (APC NH Whites: -1.04; NH Black or African Americans: -0.86). NH Asian or Pacific Islanders exhibited the lowest overall AAMR (0.35), with the AAMR decreasing from 1999 to 2018 (APC: -0.64), before a steeper decrease was observed from 2018 to 2020 (APC: -16.64). The West exhibited the highest AAMR (0.59), followed by the South (0.49), the Midwest (0.47) and the Northeast (0.45). However, some interesting trends were observed. The AAMRs declined in the Northeast and the West from 1999 to 2020 and decreased in the South from 1999 to 2014 (APC: -1.22) before increasing until 2018 (APC: 4.77). Subsequently, a sharp decrease was observed until 2020 (APC: -8.82). The AAMR in the Midwest also decreased from 1999 to 2011 (APC: -1.84) before increasing until 2020 (APC: 0.83). Upon stratification by urbanization, we identified a higher overall AAMR in rural areas (0.52) compared to urban areas (0.48). Joinpoint regression revealed a decrease in the AAMR for urban areas from 1999 to 2020 (APC: -0.60), whereas the AAMR for rural areas was observed to decrease from 1999 to 2011 (APC: -1.94) before increasing until 2020 (APC: 1.05). The highest AAMR was observed in California (0.64), Arizona (0.59), Texas (0.59), and Oklahoma (0.58), whereas the lowest was observed in Utah (0.36), Massachusetts (0.39), Louisiana (0.40), and the District of Columbia (0.40).

Conclusion

Overall, a decrease in ALL-related mortality was observed from 1999 to 2020. However, disparities were observed in ALL-related mortality trends across gender, race, census regions, and urbanization. Targeted interventions, including early screening and detection, must be initiated to combat such variations in mortality.

Disclosures: Mushtaq: Iovance Biotherapeutics: Research Funding.

*signifies non-member of ASH