Beyond overall declines: Unequal trends in multiple myeloma mortality across racial and demographic subgroups in the United States from 2018-2023

Abstract Background: Multiple myeloma (MM) mortality has declined in the United States, yet racial and demographic disparities persist. Contemporary, granular evaluation across race, region, urbanization, sex, and Hispanic origin is limited. Methods: We analyzed CDC WONDER data (2018–2023) for MM (ICD-10: C90) as the underlying cause of death. Age-adjusted mortality trends were assessed by race, census region, urbanization, sex, and Hispanic origin. Annualized percent change (APC) was calculated using log-linear regression from first to last available year. Results: From 2018–2023, APC varied widely across racial groups. American Indian/Alaska Native declined most (–8.53%/yr), Asian Indian increased (+10.88%/yr), Black was stable (–0.39%/yr), and White declined (–1.36%/yr). Among Asian subgroups, Chinese increased (+2.38%/yr), Japanese rose (+5.59%/yr), Korean declined (–5.92%/yr), Filipino decreased (–0.25%/yr), Vietnamese declined (–1.68%/yr), and Other Asian decreased (–2.78%/yr). Regionally, AI/AN declined in West (–12.23%/yr), South (–6.51%/yr), Midwest (–3.58%/yr); Asian Indian rose in South (+16.12%/yr), West (+7.21%/yr), Northeast (+5.15%/yr), Midwest (+3.23%/yr); More than one race rose in South (+13.70%/yr); White declined in all regions. Urbanization analysis showed AI/AN declined in Micropolitan (–12.20%/yr) and Medium Metro (–5.06%/yr), Asian Indian rose in Large Fringe (+15.74%/yr) and Central (+11.27%/yr), Black declined in Large Central (–1.49%/yr) but rose in Micropolitan (+2.34%/yr). By sex, AI/AN declined in females (–12.54%/yr) and males (–5.32%/yr); Asian Indian increased in females (+7.71%/yr) and males (+14.19%/yr); Black was stable in females (+0.18%/yr) and declined in males (–0.97%/yr); White declined in both sexes (~–1.4%/yr). Hispanic origin analysis showed AI/AN (Not Hispanic) declined (–9.42%/yr), Asian Indian (Not Hispanic) increased (+10.88%/yr), Black declined for both Hispanic (–1.80%/yr) and Not Hispanic (–0.39%/yr), White increased among Hispanic (+1.11%/yr) but declined among Not Hispanic (–1.63%/yr). Conclusion: Despite overall declines, significant heterogeneity persists. Increases among Asian Indian, Japanese, and certain multiracial groups, particularly in specific regions and urban contexts, underscore the need for targeted interventions. Persistent excess in Black mortality and emerging increases in Hispanic White populations warrant focused outreach, equitable access to therapies, and inclusion in clinical trials to narrow survival gaps.