Mortality trends and disparities in purpura and related hemorrhagic conditions in the elderly population in the United States from 1999 to 2023: A CDC wonder databaseanalysis

Abstract Introduction: Purpura and related hemorrhagic conditions are a spectrum of bleeding disorders consisting of various types of purpura, such as immune-related and non-immune related thrombocytopenic purpura, thrombocytopenias, qualitative platelet function abnormalities, as well as unspecified hemorrhagic conditions. Aging contributes to an increased mortality risk in those who suffer from this spectrum of disease due to increased vascular fragility, anti-coagulant use, incidence of comorbidity, and immune dysregulation. Many elderly populations also receive a delay in health care, struggle with treatment adherence, and have a higher incidence of polypharmacy, all of which may contribute to an increased mortality risk. This study analyses national mortality trends in adults aged ≥ 65 years with purpura and related hemorrhagic conditions from 1999 to 2023. Methods: The CDC WONDER Multiple Cause-of-Death dataset (1999-2023) was used to analyze mortality trends in adults aged ≥ 65 years using ICD-10 codes for purpura and related hemorrhagic conditions (D69). Results were stratified by place of death, year, sex, age group, race, U.S. census region, and state. Age-adjusted mortality rates (AAMRs) were quantified per 100,000 persons by standardizing crude mortality rates (CMRs) with 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 123,025 deaths occurred in the United States from 1999 to 2023 in adults aged ≥ 65 years with purpura and related hemorrhagic conditions. Most of the deaths occurred in medical facilities (63.38%). Overall AAMRs increased from 11.65 in 1999 to 14.46 in 2023 (AAPC: 0.98; 95%CI: 0.63 to 1.39). Men had a higher average AAMR (14.18) compared to women (9.17), and both had similar rates of increase (AAPC men: 1.01; 95%CI: 0.58 to 1.57; AAPC women: 1.02; 95%CI: 0.64 to 1.37). Average CMRs increased with age, as adults aged ≥ 85 years had the highest average CMR (25.34), followed by adults aged 75-84 years (13.19) and adults aged 65-74 years (6.48). Racially, non-Hispanic (NH) Black/African Americans had the highest average AAMR (11.89), followed by NH Whites (11.11), Hispanic/Latino (10.97), and NH Asian/Pacific Islanders (10.44). NH Asian/Pacific Islanders had the highest rate of increase in mortality rates (AAPC: 1.68; 95%CI: 1.09 to 2.97) while Hispanic/Latinos had the lowest rate of increase (AAPC: 1.06; 95%CI: 0.42 to 1.75). Regionally, the West had the highest average AAMR (11.36), followed by the South (11.26), the Midwest (11.11), and the Northeast (10.74). The West had its AAMRs increase at the highest rate, followed by the South and the Midwest (AAPC West: 2.71; 95%CI: 2.16 to 3.34; AAPC South: 1.4912; 95%CI: 1.10 to 1.84; AAPC Midwest: 0.68; 95%CI: 0.32 to 1.05). In contrast, the Northeast had stable rates spanning 1999 to 2023. Throughout the study duration, California had a death toll of 14,157, which accounted for 11.51% of statewide deaths. From 1999 to 2019, state-specific AAMRs ranged from 7.50 in Louisiana to 16.59 in West Virginia. From 2021 to 2023, state-specific AAMRs extended from 8.88 in Illinois to 30.56 in Colorado. Conclusion: Mortality rates for adults aged ≥ 65 years who suffer from purpura and related hemorrhagic conditions in the United States increased from 1999 to 2023, with clear disparities between demographic and geographic stratifications. The greatest mortality burden with reference to mortality rates was observed in adults aged ≥ 85 years, men, NH Black/African Americans, residents of the West, West Virginia from 1999 to 2019, and Colorado from 2021 to 2023. The disparities illustrate the need for extensive research to analyse risk factors and the determinants of health that contribute to the mortality rates in the elderly population at large and in at-risk communities who suffer from purpura and related hemorrhagic conditions.