The unseen bleed- temporal and demographic patterns of thrombocytopenia mortality in the United States: A 25-year analysis of the CDC wonder database

Abstract The Unseen Bleed- Temporal and Demographic Patterns of Thrombocytopenia Mortality in the United States: A 25-Year Analysis of the CDC WONDER Database Introduction: Thrombocytopenia increases the risk of bleeding with platelets between 50,000 and 100,000 with potentially life-threatening bleeding episodes with counts as low as 10,000. Primary ITP is common in younger women and similar in older males and females. Secondary Thrombocytopenia is commonly due to drugs, heparin induced thrombocytopenia (HIT), DIC or microangiopathies. Methods: Age-adjusted Mortality Rates (AAMRs) per 100,000 in adults (25+) were obtained from the CDC WONDER using ICD-10 Codes for Thrombocytopenia (D69.4-69.6). Joinpoint regression estimated Annual percent Change and average APC, with significance at p<0.05. Results: From 1999 to 2023 158,739 Thrombocytopenia related deaths occurred in adults aged 25+. The overall mortality rose from 2.6 in 1999 to 4.0 in 2023 (AAPC:2.4 ;95% CI: 0.9-3.9, p= 0.002), with 53.6% deaths attributed to males. Males had higher AAMR than females (3.4 vs 2.3), while females had a steeper rise (AAPC: 2.1% vs 1.8%). NH Blacks had the highest AAMR (3.4) followed closely by NH Alaskan Native (AN) (3.3), with the steepest rise observed in NH AN (AAPC: 2.5; 95 %CI: -1.3-6.6, p=0.210). The South had the largest AAMR (2.7), as well as the greatest rise (AAPC: 2.2; 95% CI: 1.6-2.6, P<0.000001). Non-metropolitan areas experienced higher AAMR than Metropolitan areas (3.0 vs 2.6) as well as rapid rise (2.4% vs 1.2%t). States like South Dakota had the highest AAMR (6.7) while Illinois ranked the lowest (2.13). Conclusion: Mortality due to Thrombocytopenia whether primary, secondary or unspecified is rising despite advancements in treatment is rising especially in men, NH Blacks, non-metropolitan regions and States such as South Dakota. Targeted Interventions are needed especially in high-risk groups.