Temporal trends and disparities in non-Hodgkin lymphoma related mortality along the US-Mexico border from 1999 to 2020: CDC wonder analysis

Abstract Background: Non-Hodgkin Lymphoma (NHL) is a hematological cancer that affects the lymphatic system, and is characterized by the abnormal growth of lymphocytes. NHL is the eleventh most prevalent cancer globally. In the US, it's the seventh most common cancer among men and women and accounts for about 4% of all cancer diagnoses. This study aims to analyze annual trends and sociodemographic factors in NHL-related mortality in the United States 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 adults with NHL were analyzed using data from the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiological Research (CDC WONDER) database, where NHL was a contributing or the underlying cause of death. Code: C82.0-85.0 in the International Classification of Disease, tenth revision (ICD-10) was 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 (sex, race/ethnicity, and age) and geographic (U.S. border and non-border regions) subgroups. Results: Between 1999 and 2020, 561,513 documented deaths were reported from NHL in the U.S. border regions. The overall AAMR for NHL-related mortality decreased in the US border region from an adjusted rate (AR) 10.12 in 1999 to 6.48 in 2020. The overall AAMR from 1999-2020 was 7.66 (AAPC: -2.13; 95% CI: -2.31 to -1.95; p < 0.000001). Males had consistently higher AAMRs with an AAPC of -1.95 (95% CI: -2.26 to -1.64) than females with an AAPC of -2.46 (95% CI: -2.78 to -2.15) (AAMRs: 9.93 vs 5.97). The AAMR for males decreased from 12.95 to 8.68 from 1999-2020. The AAMR for females decreased from 8.07 to 4.82 in this 21-year period. The non-Hispanic (NH) White population had the highest overall AAMR of 8.14 (AAPC: -2.01; 95% CI: -2.25 to -1.77), followed by the Black or African Americans (5.54), the Americans (5.23), and Asian or Pacific Islander population (4.76). The Hispanic or Latino population had an AAMR of 5.93 with an AAPC of -1.56 (95% CI: -1.82 to -1.29). AAMR also varied by regions. U.S. non-border regions had higher AAMR (7.68) compared to the US-Mexico border regions (7.29). Age-wise stratification showed that the age group less than 44 years had a CMR of 0.54, while the more than 45 years age group had a CMR of 20.56 accounting for the most deaths due to NHL in the U.S. border regions. Majority of these deaths (236,218 deaths) occurred in the medical inpatient facilities accounting for 42.07% of the mortality burdern. This was followed by the decedent's home (169,852 deaths), where 30.25% of the total deaths from NHL took place. Conclusion: The mortality rates from Non-Hodgkin Lymphoma generally decreased in the United States Border Regions over the 21-year study period from 1999-2020. However, significant demographic and geographic disparities in NHL-related mortality persist, with a greater burden observed among men, NH White population, individuals aged more than 45 years, and those residing in non-border U.S. regions. This highlights the need for further investigation and the development of targeted treatment strategies.