Trends in leukemia mortality with concurrent ischemic heart disease in the United States, 1999-2024: A population-based CDC WONDER analysis.
Abstract
347 Background: Leukemia and ischemic heart disease (IHD) are leading causes of morbidity and mortality, yet population-based trends for their co-occurrence remain undefined. Characterizing demographic and geographic disparities is essential for integrated hematologic and cardiovascular care. This study analyzes CDC WONDER Multiple Cause of Death data to assess leukemia mortality trends with concurrent IHD in the United States from 1999 to 2024, providing a population-based framework to identify high-risk groups and evolving disease burdens. Methods: We conducted a retrospective CDC WONDER analysis (1999-2024). Adults aged ≥ 25 years were included if leukemia (C91-C95) and IHD (I20-I25) were listed anywhere on the death certificate. Age-adjusted mortality rates (AAMR) were stratified by sex, race, age group, census region, and urbanization. Joinpoint regression calculated Annual Percent Change (APC) and Average Annual Percent Change (AAPC) with p < 0.05. Results: From 1999 to 2024, 55,577 leukemia and IHD deaths were reported. The overall AAMR declined significantly from 1999 to 2018 (APC: -2.19%, 95% CI -2.42 to -1.96), then rose significantly from 2018 to 2021 (APC: 8.21%, 95% CI: 0.43 to 16.59), and declined significantly from 2021 to 2024 (APC: -5.01%, 95% CI -8.31 to -1.59). The overall AAPC was -1.35% (95% CI -2.27 to -0.42). Males exhibited higher mortality than females throughout (2024 AAMR: 1.725 vs. 0.503). Males showed a significant decline from 1999-2018 (APC: -1.91%), a non-significant increase from 2018-2021 (APC: 8.33), and a significant decline from 2021-2024 (APC: -5.60%). Females showed significant declines from 1999-2009 (APC: -2.93%) and 2009-2017 (APC: -4.39%), a significant increase from 2017-2021 (APC: 5.01%), then a non-significant decline from 2021-2024 (APC: -2.44). By race, White decedents had an AAPC of -1.12% and Black decedents -1.65%, while Hispanic decedents showed a non-significant AAPC (-1.40). The largest decline occurred in adults aged 65-74 years (AAPC: -2.29%), whereas those aged 45-54 years showed no significant change (APC: 0.07). Regionally, the Northeast had the steepest AAPC (-1.89%), while the Midwest and South did not reach significance. By urbanization, large fringe metro areas had the greatest decline (AAPC: -2.00%), and all metropolitan categories declined significantly. Conclusions: Leukemia mortality with concurrent IHD declined overall but with a mid-period reversal (2018-2021) and persistent disparities by race, age, and geography. Targeted strategies are needed for high-risk subgroups, particularly non-Hispanic White males and older adults.