Trends in multiple myeloma mortality among patients with anemia in the United States, 1999–2024: A CDC wonder database analysis

Abstract INTRODUCTION: Anemia is a frequent and clinically significant complication in patients with multiple myeloma (MM), often reflecting advanced disease and contributing to increased mortality. However, national trends in MM-related mortality among patients with coexisting anemia remain underexplored. This study investigates long-term mortality patterns in this high-risk group using national death records from 1999 to 2024. METHODS: Data were extracted from the CDC Wide-ranging Online Data for Epidemiologic Research (CDC WONDER) database. We included decedents aged ≥65 years for whom multiple myeloma was the underlying cause and anemia was listed as a contributing cause of death. Age-adjusted mortality rates (AAMRs) were calculated per 1000,000 population. Joinpoint regression was used to assess trends and calculate annual percent changes (APCs). RESULTS: A total of 15,238 deaths were identified. The AAMR declined slightly from 14.3 in 1999 to 13.4 in 2024. A significant decline was observed from 1999 to 2007 (APC: -2.16), followed by a modest but significant increase through 2023 (APC: 0.59). Male patients had a higher AAMR (16.1) than females (11.6). Non-Hispanic African Americans experienced the highest burden (28.1), nearly double the national average. Mortality rates were higher in non-metropolitan (14.9) compared to metropolitan areas (13.1), with the Midwest showing the highest regional AAMR (13.9). CONCLUSION: While early reductions in mortality were observed among MM patients with anemia, recent upward trends and persistent disparities, particularly among African Americans and rural populations, highlight the need for targeted interventions and equity-focused healthcare strategies. Keywords: Multiple Myeloma; Anemia; Mortality Trends; CDC WONDER; Health Disparities; Rural Health; African American Health; Geriatric Hematology.