Sex, racial, and regional disparities in dementia-associated mortality among adults with hematologic malignancies in the United States, 1999–2024.

Abstract

<jats:p> <jats:bold>587</jats:bold> </jats:p> <jats:p> <jats:bold>Background:</jats:bold> Dementia is linked to poor survival in patients with hematologic malignant neoplasms (HMNs). Evidence suggests that older adults diagnosed with HMNs may experience an accelerated decline in cognitive function particularly dementia. This study evaluates temporal trends among U.S. adults ≥65 years with dementia and HMNs. <jats:bold>Methods:</jats:bold> Data was extracted from CDC WONDER database from 1999 to 2024 for dementia (F01, F03, G30-31) and HMNs (C81-C96). Age-adjusted mortality rates (AAMRs) per 100,000 and Annual Percentage Changes (APCs) with 95% CIs were calculated. Temporal trends were evaluated using Joinpoint regression, categorized by age, gender, ethnicity, geographic region and urbanization. <jats:bold>Results:</jats:bold> Between 1999 and 2024, 58,840 dementia and HMNs-related deaths occurred among adults ≥65 years. Males consistently had higher mortality rates compared to females. Mortality was markedly elevated in the early period from 1999-2001 (APC 26.1%), followed by a slower rise from 2001 to 2008 (APC 1.1%) and then a more pronounced rise from 2008 to 2021 (APC 9.2%). Mean AAMRs were comparable between African Americans and Whites (5.18 vs 5.20). Among Whites mortality rates initially increased from 1999 to 2001 (APC 20.8%) followed by a modest increase from 2018 to 2021 (APC 7.4%). AAMR also varied substantially by region (overall AAMR: Midwest 5.7; West: 5.1; South: 4.8; Northeast: 4.4). Rural population had higher mortality rates compared to urban population. <jats:bold>Conclusions:</jats:bold> HMNs and dementia-related mortality among older adults has shown a sustained increase over the past two decades, with a slight decline after 2021. Significant disparities persisted with higher mortality observed among males, and rural populations. These findings highlight the need for improved risk stratification, early cognitive assessment, and targeted preventive strategies in patients with HNMs to reduce dementia risks. <jats:table-wrap orientation="portrait" position="anchor"> <jats:caption content-type="mtgabstract-table-title"> <jats:p>AAPC values for overall, sex, race/ethnicity, census region, and urbanisation.</jats:p> </jats:caption> <jats:table content-type="mtgabstract"> <jats:thead content-type="mtgabstract"> <jats:tr> <jats:th colspan="1" content-type="border-bottom align-left" rowspan="1">Variable</jats:th> <jats:th colspan="1" content-type="border-bottom" rowspan="1">Duration</jats:th> <jats:th colspan="1" content-type="border-bottom" rowspan="1">AAPC</jats:th> <jats:th colspan="1" content-type="border-bottom" rowspan="1">Lower 95% CI</jats:th> <jats:th colspan="1" content-type="border-bottom" rowspan="1">Upper 95% CI</jats:th> <jats:th colspan="1" content-type="border-bottom" rowspan="1">P-value</jats:th> </jats:tr> </jats:thead> <jats:tbody> <jats:tr> <jats:td colspan="1" content-type="row-heading" rowspan="1">Overall</jats:td> <jats:td colspan="1" rowspan="1">1999–2024</jats:td> <jats:td colspan="1" rowspan="1">2.7796</jats:td> <jats:td colspan="1" rowspan="1">1.9848</jats:td> <jats:td colspan="1" rowspan="1">3.6478</jats:td> <jats:td colspan="1" rowspan="1"><0.000001</jats:td> </jats:tr> <jats:tr> <jats:td colspan="1" content-type="row-heading" rowspan="1">Female</jats:td> <jats:td colspan="1" rowspan="1">1999–2024</jats:td> <jats:td colspan="1" rowspan="1">2.5152</jats:td> <jats:td colspan="1" rowspan="1">1.0974</jats:td> <jats:td colspan="1" rowspan="1">3.7913</jats:td> <jats:td colspan="1" rowspan="1"><0.000001</jats:td> </jats:tr> <jats:tr> <jats:td colspan="1" content-type="row-heading" rowspan="1">Male</jats:td> <jats:td colspan="1" rowspan="1">1999–2024</jats:td> <jats:td colspan="1" rowspan="1">3.2082</jats:td> <jats:td colspan="1" rowspan="1">2.6773</jats:td> <jats:td colspan="1" rowspan="1">3.8694</jats:td> <jats:td colspan="1" rowspan="1"><0.000001</jats:td> </jats:tr> <jats:tr> <jats:td colspan="1" content-type="row-heading" rowspan="1">Black or African American</jats:td> <jats:td colspan="1" rowspan="1">1999–2024</jats:td> <jats:td colspan="1" rowspan="1">2.8138</jats:td> <jats:td colspan="1" rowspan="1">1.3182</jats:td> <jats:td colspan="1" rowspan="1">4.1577</jats:td> <jats:td colspan="1" rowspan="1"><0.000001</jats:td> </jats:tr> <jats:tr> <jats:td colspan="1" content-type="row-heading" rowspan="1">White</jats:td> <jats:td colspan="1" rowspan="1">1999–2024</jats:td> <jats:td colspan="1" rowspan="1">3.0855</jats:td> <jats:td colspan="1" rowspan="1">2.2211</jats:td> <jats:td colspan="1" rowspan="1">4.1040</jats:td> <jats:td colspan="1" rowspan="1"><0.000001</jats:td> </jats:tr> <jats:tr> <jats:td colspan="1" content-type="row-heading" rowspan="1">Northeast</jats:td> <jats:td colspan="1" rowspan="1">1999–2024</jats:td> <jats:td colspan="1" rowspan="1">1.8636</jats:td> <jats:td colspan="1" rowspan="1">1.4304</jats:td> <jats:td colspan="1" rowspan="1">2.3843</jats:td> <jats:td colspan="1" rowspan="1"><0.000001</jats:td> </jats:tr> <jats:tr> <jats:td colspan="1" content-type="row-heading" rowspan="1">Midwest</jats:td> <jats:td colspan="1" rowspan="1">1999–2024</jats:td> <jats:td colspan="1" rowspan="1">2.9300</jats:td> <jats:td colspan="1" rowspan="1">1.4290</jats:td> <jats:td colspan="1" rowspan="1">4.2933</jats:td> <jats:td colspan="1" rowspan="1"><0.000001</jats:td> </jats:tr> <jats:tr> <jats:td colspan="1" content-type="row-heading" rowspan="1">South</jats:td> <jats:td colspan="1" rowspan="1">1999–2024</jats:td> <jats:td colspan="1" rowspan="1">2.9751</jats:td> <jats:td colspan="1" rowspan="1">2.5342</jats:td> <jats:td colspan="1" rowspan="1">3.6340</jats:td> <jats:td colspan="1" rowspan="1"><0.000001</jats:td> </jats:tr> <jats:tr> <jats:td colspan="1" content-type="row-heading" rowspan="1">West</jats:td> <jats:td colspan="1" rowspan="1">1999–2024</jats:td> <jats:td colspan="1" rowspan="1">3.3031</jats:td> <jats:td colspan="1" rowspan="1">1.7287</jats:td> <jats:td colspan="1" rowspan="1">4.7764</jats:td> <jats:td colspan="1" rowspan="1"><0.000001</jats:td> </jats:tr> <jats:tr> <jats:td colspan="1" content-type="row-heading" rowspan="1">Large Central Metro</jats:td> <jats:td colspan="1" rowspan="1">1999–2020</jats:td> <jats:td colspan="1" rowspan="1">2.7464</jats:td> <jats:td colspan="1" rowspan="1">1.2422</jats:td> <jats:td colspan="1" rowspan="1">4.2109</jats:td> <jats:td colspan="1" rowspan="1"><0.000001</jats:td> </jats:tr> <jats:tr> <jats:td colspan="1" content-type="row-heading" rowspan="1">Large Fringe Metro</jats:td> <jats:td colspan="1" rowspan="1">1999–2020</jats:td> <jats:td colspan="1" rowspan="1">3.0444</jats:td> <jats:td colspan="1" rowspan="1">2.4337</jats:td> <jats:td colspan="1" rowspan="1">3.9535</jats:td> <jats:td colspan="1" rowspan="1"><0.000001</jats:td> </jats:tr> <jats:tr> <jats:td colspan="1" content-type="row-headi