The constant burden-aplastic anaemia as the underlying cause of death in older US adults- half century insights from the CDC wonder database (1968-2023)

Abstract Introduction: Aplastic Anemia is a serious blood disorder affecting roughly 2 persons per million in United States with severe cases in a bimodal distribution (ages 2-14 or above 60 years). Methods: Age-adjusted mortality rates (AAMRs) per 100, 000 in adults (25+) were obtained from the CDC WONDER using ICD-8, ICD-9 and ICD-10 codes for Aplastic Anemia. Joinpoint regression estimated Annual Percent Change and Average APC, with significance at p<0.05. Results: From 1968 to 2023, Aplastic Anemia was responsible for 57,679 deaths. The overall AAAMR declined from 10.3 in 1968 to 3.7 in 2023 with a peak decline at 3.42020 (AAPC: -1.8%, p<0.000001). The sharpest decline occurred between 1999-2002 (APC: -9.5%, p=0.000065). Men had higher AAMR than women (8.0 vs 5.9), with a steeper decline in mortality (AAPC: -2.0% vs -1.8%, p<0.000001). In terms of Race, Whites had higher AAMRs than Blacks (6.8 vs 5.9) and a steeper fall (AAPC: -1.8% vs -1.2%). More than 78% deaths occurred in older age groups (65+). Midwest had the highest AAMR (7.1), while the West had the steepest decline (AAPC: -2.1, p<0.000001). States with the highest mortality included Montana, Idaho and Wyoming while New York, Arizona and California had the lowest. Conclusion: Due to progress in Hematopoietic Stem cell Transplantation (HCT) and Immunosuppressive therapy (ICT), survival rates have significantly improved though disparities still exist particularly in men, Whites, those from the Midwest and older age groups. Targeted Interventions are needed in high-risk groups.