Abstract

 

Background

Although multiple myeloma (MM) predominantly affects older adults, deaths before age 55 represent an important

form of premature mortality, occurring during working, caregiving, and potentially transplant-eligible years. The

national burden of early-onset MM mortality, its contribution to years of potential life lost (YPLL), and how this

burden differs across demographic and geographic groups remain incompletely defined.

 

Methods

We analyzed CDC WONDER (Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic

Research) mortality data from 1999–2024 for deaths with MM as the underlying cause of death, defined

by ICD-10 code C90.0. Early-onset MM mortality was defined as death at ages 25–54 years. Nonoverlapping

bridged-race data from 1999 to 2020 and single-race data from 2021 to 2024 were combined for national trend

and YPLL analyses. Outcomes included annual deaths, crude mortality rates, log-linear annual percent change,

YPLL before age 75 years (YPLL-75), mean YPLL per death, and the proportion of total MM-related YPLL-75

attributable to early-onset deaths. Modern-period disparities were assessed using 2018–2024 single-race data

by race, sex, and census region. Sensitivity analysis used multiple-cause-of-death records with MM listed

anywhere on the death certificate.

 

Results

From 1999–2024, 17986 MM deaths occurred among adults aged 25–54 years. Crude early-onset MM mortality

decreased from 0.6624 per 100000 in 1999 to 0.2915 per 100000 in 2024, corresponding to an approximate 2.7%

annual decline. Despite this improvement, early-onset deaths accounted for approximately 464615 YPLL-75,

with a mean of 25.8 years lost per death. Adults aged 25–54 years represented only 6.1% of all MM deaths but

contributed 31.4% of total MM-related YPLL-75, demonstrating a 5-fold disproportionate premature mortality

burden. During 2018–2024, mortality rates were higher among Black vs White adults (rate ratio [RR], 2.48), men

vs women (RR, 1.41), and residents of the South vs West (RR, 1.47). Sensitivity analysis using multiple-cause-of-

death records confirmed a similar decline in MM-associated early-onset mortality.

 

Conclusions

Early-onset MM mortality has declined substantially in the United States; however, deaths among adults aged 25–

54 years contribute disproportionately to MM-related life-years lost. Persistent racial, sex-based, and regional

disparities underscore the need for earlier recognition, timely referral, and equitable access to specialized MM

care.

 

ICD-10: International Classification of Diseases, Tenth Revision

 

Keywords

MM, premature mortality, early-onset, years of potential life lost, health disparities