Aplastic anemia mortality in the United States (1999–2023): Trends, disparities, and public health implications

Abstract Background: Aplastic anemia is a rare, life-threatening hematological disorder characterized by bone marrow failure and pancytopenia. Despite its low prevalence, the condition's severity and potential for rapid clinical deterioration necessitate comprehensive epidemiological surveillance to inform clinical practice and public health policy. Objective: To analyze mortality trends and identify demographic, racial, and geographic disparities in aplastic anemia-related deaths in the United States over a 24-year period. Methods: We conducted a retrospective population-based analysis of aplastic anemia-related mortality data from 1999 to 2023. Age-adjusted mortality rates (AAMR) were calculated and stratified by sex, race/ethnicity, geographic region, and metropolitan status. Temporal trends were assessed using joinpoint regression analysis. Confidence intervals (95% CI) were calculated for all estimates. The data were obtained from the CDC-WONDER Database (), and the study was conducted as per the STROBE guidelines. Result: From 1999 to 2023, there were a total of 130,437 aplastic anemia-related deaths. The overall age-adjusted mortality rate (AAMR) showed a declining trend from 1999 to 2015, followed by a rise in the trend from 2015 to 2023. Males had consistently higher AAMR than females (AAMR: 2.84; 95% CI: 2.77 to 2.99 and 1.95; 95% CI: 1.88 to 2.03), respectively. Significant racial disparities were observed, with American Indians having the highest AAMR (2.62; 95% CI:1.78 to 3.78), followed by African Americans (2.55; 95% CI: 2.33 to 2.77), NH Whites (2.33; 95% CI: 2.26 to 2.41), Hispanics (2.09; 95% CI: 1.87 to 2.32), and others (1.80; 95% CI: 1.50 to 2.10). Similarly, regional disparities were also observed, with the Midwest having the highest AAMR (2.48; 95% CI: 2.34 to 2.62), followed by the South (2.40; 95% CI: 2.29 to 2.51), West (2.34; 95% CI: 2.20 to 2.48), and Northeast (2.01; 95% CI: 1.87 to 2.14). Both metropolitan and non-metropolitan areas experienced trends in aplastic anemia mortality, with non-metropolitan areas showing higher AAMRs (2.61;95% CI: 2.44 to 2.77) than metropolitan areas (2.19; 95% CI: 2.12 to 2.26) Conclusion: This comprehensive analysis reveals persistent and significant disparities in aplastic anemia mortality across demographic, racial, and geographic lines in the United States. The recent upturn in mortality trends since 2015, coupled with disproportionate burden among males, certain racial minorities, and rural populations, highlights the need for targeted interventions and equitable access to specialized hematological care. These findings have important implications