Disparities in autoimmune hemolytic Anemia–Related mortality in the u.S.–Mexico border region, 1999–2020: A CDC wonder study.

Abstract Background: Autoimmune hemolytic anemia (AIHA) is a rare but potentially life-threatening condition characterized by the premature destruction of red blood cells due to autoantibodies targeting self-antigens. It poses significant diagnostic and therapeutic challenges. This study aims to analyze annual trends in AIHA-related mortality in the United States-Mexico Border Regions from 1999 to 2020, to assess public health initiatives, and highlight areas needing targeted intervention. This will guide future directions to improve patient outcomes and public health approaches for prevention and treatment strategies. Methods: The mortality trends among individuals aged <1-85+ with AIHA were analyzed using data from the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiological Research (CDC WONDER) database, where AIHA was a contributing or the underlying cause of death. Codes D59.0 (Drug-induced autoimmune haemolytic anaemia), and D59.1 (Other autoimmune haemolytic anaemias) in the International Classification of Disease, tenth revision (ICD-10) were used to identify the data. Crude and age-adjusted mortality rates (AAMRs) per 100,000 people were extracted. Annual percent changes (APCs) and average annual percent changes (AAPCs) in AAMRs with 95% CI were obtained using joint point regression analysis. Data were stratified across different demographic and geographic subgroups. Results: From 1999-2020, a total of 7,015 deaths were reported from autoimmune hemolytic anemia (AIHA) in the US-Mexico Border Region. The AAMR decreased consistently with an adjusted rate (AR) of 1.26 in 1999 to 0.96 in 2020. The overall AAMR for this period was 0.97 (AAPC: -1.77; 95% CI: -2.58 to -0.93; p = 0.000031). From 1999 to 2009, the mortality rate decreased at an APC of -4.08 (95%CI: -5.42 to -2.72), whereas from 2009 to 2020, mortality rate increased slightly at an APC of 0.38 (95% CI: -0.77 to 1.55). Men had higher overall AAMR (1.05) with an AAPC of -0.60 (95% CI: -2.25 to 1.07), compared to women (AAMR: 0.90) with an AAPC of -2.15 (95% CI: -3.57 to -0.70). The AAMR for males declined from 1.4 in 1999 to 0.87 in 2009. However, it increased to 1.06 in 2010, followed by a continued decline in the subsequent years. This downward trend reversed again in 2019, with the AAMR rising to 1.01, and further increasing to 1.18 in 2020. For females, there was a consistent drop in AAMR from 1.18 in 1999 to 0.82 in 2007. AAMR showed a slight upward shift in 2008 (0.96) but declined thereafter reaching 0.78 in 2020. Mortality rates also showed regional and ethnic variations. Non-hispanic (NH) White population had the highest overall AAMR of 1.03 (AAPC: -1.71; 95% CI: -2.57 to -0.83) while Hispanic or Latino population had an AAMR of 0.56. Regional mortality trends were also visible with the U.S. non border region having an AAMR of 0.97. The age group 85+ showed the highest mortality with a CMR of 1.62 followed by the 75-84 age group with a CMR of 0.75. Majority of the deaths (4,026 deaths) occurred in inpatient medical facilities accounting for 57.4% of the total AIHA-related deaths in the US-Mexico Border Region. Conclusion: The mortality rates from autoimmune hemolytic anemia generally decreased in the US-Mexico Border Region over the 21-year study period from 1999-2020. However, significant demographic and geographic disparities in AIHA-related mortality persist, with a greater burden observed among men, NH White population, individuals aged >85 years, and those residing in non-border U.S. regions. This highlights the need for further investigation and the development of targeted treatment strategies.