Trends and disparities in anemia and COPD-related mortality among adults in the United States from 1999 to 2023: A CDC wonder database analysis

Abstract Introduction: Anemia and COPD are among the most common diseases in the United States, and when paired, accelerate morbidity and mortality. Among COPD patients, anemia is a common co-morbidity, with a prevalence ranging from 7.5 to 33%. Anemia decreases the oxygen-carrying capacity of blood, leading to impaired oxygen delivery to tissues already hypoxic at baseline in COPD patients. Growing clinical evidence suggests that those with COPD and comorbid anemia face higher in-hospital and outpatient mortality rates than those without anemia. Long-term mortality trend analyses related to adults with anemia and COPD in the United States remain limited. This study analyses national anemia and COPD-related mortality trends in adults aged ≥ 25 years from 1999 to 2023. Methods: The CDC WONDER Multiple Cause-of-Death dataset (1999-2023) was used to analyze mortality trends in adults aged ≥ 25 years using ICD-10 codes for anemia (D55-D59, D60-D64) and COPD (J44). Results were stratified by place of death, year, sex, race, U.S. census region, and state. Age-adjusted mortality rates (AAMRs) were calculated per 100,000 with corresponding 95% confidence intervals (95%CI). Annual percent change (APC) and average annual percent change (AAPC) were calculated using Joinpoint regression software. A p-value of < 0.05 was defined as statistical significance. Results: A total of 156,799 anemia and COPD-related deaths occurred in the United States from 1999 to 2023 in adults aged ≥ 25 years. Most of the deaths occurred in medical facilities (41.67%), followed by nursing/long term care facilities (27.14%), the decedent's home (23.60%), hospices (4.16%), and other/place of death unknown (3.43%). Overall AAMRs increased from 2.50 in 1999 to 2.83 in 2023 (AAPC: 0.38; 95%CI: 0.16 to 0.59). Men had a higher average AAMR (3.46) compared to women (2.40), and displayed decreasing rates while women saw increasing rates (AAPC men: -0.47; 95%CI: -0.73 to -0.26; AAPC women: 1.03; 95%CI: 0.71 to 1.38). Racially, non-Hispanic (NH) Black/African Americans had the highest average AAMR (2.97), followed by NH Whites (2.96), Hispanic/Latino (1.64), and NH Asian/Pacific Islanders (1.27). NH Whites exhibited increasing mortality rates, NH Asian/Pacific Islanders saw decreasing rates (AAPC NH White: 0.80; 95%CI: 0.59 to 1.00; AAPC NH Asian/Pacific Islander: -1.58; 95%CI: -2.98 to -0.01) while NH Black/African Americans and Hispanic/Latinos had stable rates. The Midwest had the highest average AAMR (3.15), followed by the South (2.94), Northeast (2.51), and the West (2.48). The South and the West displayed increasing mortality rates (AAPC South: 0.99; 95%CI: 0.67 to 1.35; AAPC West: 0.40; 95%CI: 0.12 to 0.74) while the Northeast and Midwest had stable rates. State-wise, California had the greatest amount of deaths at 16,057 (10.24%) while the District of Columbia had the least amount of deaths at 183 (0.12%). States in the top 90th percentile of deaths included California, Texas, Florida, Ohio, and Pennsylvania, while states in the bottom 10th percentile were Hawaii, Wyoming, Utah, Alaska, and the District of Columbia. Conclusion: Anemia and COPD-related mortality rates for adults aged ≥ 25 years increased slowly from 1999 to 2023, with distinct disparities between demographic and geographic stratifications. The greatest mortality burden concerning mortality rates was observed in men, NH Black/African Americans, and residents of the Midwest. States with the highest number of deaths were California, Texas, Florida, Ohio, and Pennsylvania. These disparities in mortality illustrate the urgent need for further research to analyse the determinants of health along with risk factors that contribute to the increased mortality burden, especially in at-risk communities who are affected by anemia and COPD, so that equitable health care may be achieved to improve mortality outcomes.