Chronic Lower Respiratory Disease Mortality in Adults With Hematologic Malignancies: A 25-Year National Perspective on Trends and Disparities in United States 

Authors:

1.Rumman Javed

Ayub Medical College, Abbottabad

Pakistan

javedrumman@gmail.com

ORCID:0009-0004-8751-6823

2. Prachi Dawer

University College of Medical Sciences, New Delhi

prachidawar59@gmail.com

 3. Muhammad Mukhlis

Ayub Medical College, Abbottabad

mukhlishussain96@gmail.com

 4. Aizaz Anwar Khalid

Peshawar Medical College, Peshawar, Pakistan

aizazanwar00@gmail.com

 

Background

Adults with hematologic malignancies face an elevated risk for chronic lower respiratory diseases (CLRD) due to cumulative exposure to immunosuppressive therapies, smoking, and environmental pollutants. Despite this, the long-term burden and temporal trends in CLRD-associated mortality among this population remain poorly quantified at the national level.

 

Methods

We queried the CDC WONDER database to extract mortality data of individuals aged ≥45 years with hematologic malignancies (ICD-10: C81–C85, C88, C90–C95) listed in MCD fields, along with concurrent chronic lower respiratory disease codes (ICD-10: J40–J47). Age-adjusted mortality rates (AAMRs)/ 100,000  were extracted. Joinpoint regression software was used to determine annual percent changes (APCs) and their associated 95% confidence intervals (CIs), with statistical significance defined as p < 0.05.

 

Results

This retrospective study revealed a total of 89845 deaths from 1999 to 2023. A marginal rise in AAMRs was recorded from 3.02 in 1999 to 3.15 in 2023 (AAPC: 0.1554; 95% CI: -0.75 to 1.07). Men were at a higher risk of mortality (4.35) as compared to women (2.03). Assessing the race, Non-Hispanic White individuals encountered the highest AAMR (3.2), followed by Non-Hispanic Blacks or African Americans (1.95) and Hispanics or Latinos (1.25). Regionally, the population of the Midwest region faced the highest increase in mortality rates (AAMR 3.55). Also, rural areas showed higher mortality rates with a greater APC in mortality (AAMR: 3.87, AAPC: 1.03; 95% CI: 0.37 to 1.70) as compared to urban areas (AAMR: 2.74, AAPC: 0.23; 95% CI: -0.30 to 0.77). States in the top 90th percentile were Oklahoma, Nebraska, and Kentucky; in contrast, states in the lower 10th percentiles were Hawaii, the District of Columbia, and Utah. Elderly individuals (85+ age group) had the highest rate of mortality with an AAMR of 9.95 (AAPC: 1.35; 95% CI: -0.50 to 3.24).

 

Conclusions

Our study shows an overall increase in CLRD–related deaths among adults aged ≥45 with hematologic malignancies in the United States from 1999 to 2023. These findings underscore the urgent need for integrated respiratory-oncology care, tobacco cessation efforts, and proactive pulmonary screening in hematologic cancer survivorship models.

 

Keywords: Hematologic malignancies, Chronic respiratory disease, COPD, Health disparities.