National trends and demographic disparities in Hodgkin disease mortality across the United States, 1999–2024

Abstract Background: Despite advances in treatment leading to significant improvements in outcomes for Hodgkin disease (HD), demographic and geographic disparities in mortality remain inadequately characterized. Understanding these disparities over time is crucial to inform public health strategies to reduce the disease burden across diverse populations. We examined national trends in HD mortality in the U.S. from 1999 to 2024, focusing specifically on differences by sex, race/ethnicity, and urbanization. Methods: We analyzed U.S. national mortality data from the Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research (CDC WONDER) for the years 1999–2024, identifying deaths with Hodgkin disease as the underlying cause (International Classification of Diseases [ICD] code C81). Age-adjusted mortality rates (AAMR) per 100,000 individuals were calculated using the 2000 U.S. standard population. Temporal trends were assessed by sex, race/ethnicity, and urban versus rural residence. Annual percent change (APC) and average annual percent change (AAPC) were estimated to characterize overall and segment-specific changes in mortality. Urbanization data were available through 2020, and mortality data for 2024 are provisional. Results: Between 1999 and 2024, a total of 30,085 Hodgkin disease-related deaths were recorded in the United States. The overall age-adjusted mortality rate (AAMR) decreased substantially from 0.51 (95% CI: 0.48 to 0.53) per 100,000 in 1999 to 0.22 (95% CI: 0.21 to 0.24) in 2024, with an average annual percent change (AAPC) of –2.93% (95% CI: –3.25 to –2.59). Joinpoint analysis identified three distinct periods: a moderate decline from 1999 to 2010 (APC: –2.52%), an accelerated decline from 2010 to 2019 (APC: –4.57%), and a plateau thereafter from 2019 to 2024 (APC: –0.86%). Mortality consistently remained higher among males compared to females throughout the study period (total deaths: 17,174 vs. 12,911; 2024 AAMR: 0.30 vs. 0.15 per 100,000). Females, however, experienced a greater average annual decline (AAPC: –3.72%) than males (AAPC: –2.88%). By race/ethnicity, the AAMR among Non-Hispanic Whites declined from 0.53 to 0.23 per 100,000 (AAPC: –3.02%). By 2024, the corresponding mortality rates among Non-Hispanic Blacks and Hispanics were 0.16 and 0.29 per 100,000, respectively, with average annual declines (AAPC) of –2.90% for Non-Hispanic Blacks and –2.33% for Hispanics. Recent trends, however, showed a decelerating decrease in mortality rates among Non-Hispanic Whites (APC: –1.23%, 2017–2024), whereas patterns varied among Non-Hispanic Blacks and Hispanics. Urban and rural areas exhibited similar mortality rates and trends throughout the study. Urban AAMR decreased from 0.52 to 0.25 per 100,000 (AAPC: –3.47%), while rural areas declined from 0.48 to 0.31 per 100,000 (AAPC: –2.73%). Despite this similar trend pattern, rural areas maintained a slightly higher mortality rate in 2024 and a comparatively slower pace of reduction over the entire study period. Conclusions: Hodgkin disease mortality in the U.S. has significantly declined over the past 26 years, reflecting notable progress in disease management. Nonetheless, persistent disparities remain, particularly affecting males and rural populations. Continued efforts targeting these populations are essential to achieve equitable improvements in outcomes.