Multiple Myeloma Mortality Trends and Racial Disparities in the United States and Texas: A 20-Year Study (1999-2020): CDC Wonder Database
Authors: Naz Sidra , Yousaf Muhammad Sheraz , Taqdees Aqsa , Jose Thulasee 
Published: December 2024

Introduction: Multiple myeloma (MM) is a hematological cancer marked by abnormal plasma cells that produce monoclonal immunoglobulins. It is the second most common blood cancer, with increasing global incidence rates. This study aims to analyze annual trends and sociodemographic factors in MM-related mortality in the United States and Texas from 1999 to 2020, to assess public health initiatives, highlight areas needing targeted intervention, and guide future directions to improve patient outcomes and public health approaches for prevention and treatment strategies.

Methods: The mortality trends among adults aged ≥25 with MM were analyzed using data from the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiological Research (CDC WONDER) database, where MM was presented as a contributing or the underlying cause of death. Code C90.0 “Multiple Myeloma-Malignant neoplasms” in the International Classification of Disease, tenth revision (ICD-10) was used to identify the data. Crude and age-adjusted mortality rates (AAMRs) per 100,000 people were extracted. Annual percent changes (APCs) in AAMRs with 95% CI were obtained using joint point regression analysis across different demographic (sex, race/ethnicity, and age) and geographic (state, urban-rural, and regional) subgroups.

Results: Between 1999 and 2020, 294263 documented deaths were attributed to MM. The overall AAMR for MM-related mortality decreased in the US from an adjusted rate (AR) 7 in 1999 to 5.9 in 2009 (APC: -2.02%; 95% CI: -1.83% to -3.17%), after which it increased to 6.1 in 2012 (APC: 1.05%; 95% CI: 1.85% to -0.45%) and decreased to 5.7 in 2018 (APC: -1.15%; 95% CI: -0.68% to -2.43%) and increased to 5.9 in 2020 (APC: 1.30%; 95% CI: 2.60% to -0.61%). In Texas AAMR for MM-related mortality decreased from AR 7.2 in 1999 to 5.2 in 2009 (APC: -2.39%; 95% CI: -1.33% to -5.43%) after which it increased to 5.9 in 2020 (APC: 0.15%; 95% CI: 2.85% to -0.68%). Males had higher consistently higher AAMRs than females (7.6 vs. 4.6). The AAMR in the US men decreased from 8.7 in 1999 to 7.6 in 2020 (APC: -0.82%; 95% CI: -0.64% to -1.01%). The AAMR in the US women decreased from 5.8 in 1999 to 4.6 in 2020 (APC: -1.37%; 95% CI: -1.18% to -1.57%). The non-Hispanic (NH) Black or African American (AA) population has the greatest AAMR (11.8), followed by the NH White population (5.4) and the Hispanic or Latino population with AAMR (5). The low-risk population was NH American Indian or Alaska Native with AAMR (4.4) and NH Asian or Pacific Islander (2.9). AAMR also varied by region (overall AAMR: Midwest:6.3; South:6.1; West: 5.6; Northeast:5.3) and non-metropolitan areas had higher AAMR (small metro: 6; non-core areas:5.8; micropolitan areas:5.9) than metropolitan areas (large central metropolitan areas:5.7; large fringe areas:5.6). The states in the upper 90th percentile of NHL-related AAMRs were Louisiana, Tennessee, South Carolina, Virginia, Maryland, North Carolina, and Maine exhibited an approximately two-fold increase in AAMRs, compared to states falling in the lower 10th percentile.

Conclusions: The mortality rates from multiple myeloma have generally increased in the United States and Texas over the last two decades. However, significant demographic and geographic disparities in MM-related mortality persist, highlighting the need for further investigation and the development of targeted treatment strategies.