Twenty-five-year mortality trends of aplastic and secondary anemias in diabetic adults of the United States (U.S.): A CDC wonder multiple cause of death analysis (from 1999 to 2023)

Abstract Introduction: Aplastic anemia, characterized by bone marrow failure leading to pancytopenia. In parallel, secondary anemias, often resulting from chronic inflammation, renal disease, or nutritional deficiencies remain prevalent conditions. Notably, diabetes mellitus is a major cause of morbidity and mortality due to its systemic complications. Hence, diabetic adults are at heightened risk of both secondary and aplastic anemias, as diabetes contributes to persistent systemic inflammation, declines in renal function, and nutritional deficiencies, all of which further suppress bone marrow function. exacerbates these hematological abnormalities Method: Mortality data were extracted from the CDC WONDER database, utilizing multiple causes of mortality dataset with ICD-10 codes (D60-D64) for aplastic anemia and other anemiasand (E10-E14) for diabetes mellitus. Age-adjusted mortality rates (AAMR) were calculated per million population. Joinpointregression identified temporal trends, estimating annual percentage changes (APC) in mortality. Stratified analyses were conducted for demographic subgroups. Results: From 1999 to 2023, a total of 180,932 deaths were reported due to aplastic and other anemias among the diabetic population with an age adjusted mortality of 4.4 per 100,000. Both sexes exhibited a similar trend with higher AAMR in males from 2.94 to 5.29 (AAPC = 2.32 ,95%CI:1.26-3.40) than females from 2.6 to 3.89 (AAPC = 1.42 ,95%CI:0.27-2.58). Region specific analysis showed a similar trend till 2019 followed by sharp rise among all regions, highest exhibited by the West and lowest in the Midwest. AAMR across all racial groups showed variable trends with an overall increase (2019-2023) in mortality, highest reported in Black/African American (6.12 to 7.58) followed by White (0.29-0.64). Hispanic or Latino individuals showed statistically insignificant trend. Non-metropolitan areas experienced a more significant surge in mortality. The AAMR varied among the different age groups, highest reported among65-84 i.e. old age individuals, with a steady increase from 11.82 to 16.0 by 2006 (APC = 4.01), then it declined by 2018 to 14.67(APC = -1.39), followed by an increase of 20.58 by 2021 (APC = 13.65) with reversal in final trend of 18.94 by 2023 (APC = - 4.24). State variations were evident from age adjusted rates, with highest reported by West Virginia (5.80) and lowest by Nevada, (1.31). Conclusion: Mortality from aplastic and secondary anemias, along with the coexisting diabetes mellitus patients, remains a significant disparity in different groups of people in the U.S from 1999 to 2023. These demographic variations underscore an urgent need for targeted prevention and care strategies in high-risk groups. Key Words: Aplastic anemia, Diabetes Mellitus, Secondary anemias, Mortality trends.