Abstract

 

Background

Venous thromboembolism (VTE) is a potentially preventable, fatal complication of multiple myeloma (MM).

Although MM-related thrombosis is well recognized, patterns of MM-associated VTE mortality and pulmonary

embolism (PE) burden remain poorly characterized.

 

Methods

We queried CDC WONDER Multiple Cause of Death files for US deaths mentioning MM (International Classification

of Diseases, 10th Revision [ICD-10] C90.0). VTE-associated MM deaths required C90.0 plus PE (I26),

phlebitis/thrombophlebitis (I80), or other venous embolism/thrombosis (I82); PE-associated deaths required

C90.0 plus I26. Long-term trends used the 1999–2020 bridged-race file; 2018–2024 trends and disparities used

the single-race file. Descriptive 1999–2024 endpoints appended 2021–2024 single-race estimates, while annual

percent change (APC) testing was limited to the internally consistent 1999–2020 bridged-race period. Outcomes

included deaths, age-adjusted mortality rates (AAMRs), VTE share of MM deaths, PE fraction among VTE deaths,

and log-linear APC.

 

Results

Across descriptive 1999–2024 endpoints, overall MM AAMR decreased from 4.5051 to 3.2828 per 100000

(−27.1%). In contrast, MM+VTE AAMR increased from 0.0445 to 0.0723 (+62.5%), and MM+PE AAMR increased

from 0.0319 to 0.0537 (+68.3%). VTE accounted for 1.09% of MM-associated deaths in 1999 vs 2.41% in 2024.

In 1999–2020 bridged-race analysis, overall MM AAMR decreased (APC, −1.0%; 95% confidence interval [CI],

−1.2% to −0.8%), whereas MM+ VTE AAMR increased (APC, +1.4%; 95% CI, +0.6% to +2.3%) and VTE share

rose (APC, +2.1%; 95% CI, +1.5% to +2.8%). From 2018–2024, 2229 MM+ VTE deaths were identified; 1405

involved PE (63.0%). MM+ VTE mortality was higher among males than females (AAMR, 0.0926 vs 0.0537; rate

ratio, 1.72) and highest among non-Hispanic Black decedents (AAMR, 0.1847), nearly 2.8-fold higher than non-

Hispanic White decedents (0.0663). Adults aged 65 years or older accounted for 81.8% of MM+ VTE deaths.

 

Conclusions

Despite declining overall MM-associated mortality, VTE- and PE-associated mortality increased, and VTE represented

a growing share of MM deaths. PE accounted for most MM+ VTE death certificates, with disproportionate

mortality among males, older adults, and non-Hispanic Black decedents. These findings support targeted thrombosis-risk

mitigation, PE prevention, and equity-focused supportive care in MM.

 

Keywords

MM, multiple myeloma, venous thromboembolism, pulmonary embolism, mortality trends, health disparities