Trends in coagulation defects related mortality in adults in the United States - a retrospective analysis from 1999-2023.

Abstract Introduction: Coagulation disorders represent a heterogeneous group of conditions characterized by impaired hemostatic function, ranging from inherited bleeding disorders to acquired coagulopathies. Coagulation defects constitute a significant health concern in the United States, affecting hundreds of thousands of individuals and contributing substantially to morbidity and mortality. Objective: Trends and regional variations in U.S. mortality from 1999-2023 were analyzed in correlation to coagulation defects. Methods: The CDC WONDER database (1999–2023) was utilized to examine age-adjusted mortality rates (AAMR) and annual percent change (APC) among U.S. adults aged 65 and older with MCD - ICD-10 Codes: D65-D69 (Coagulation defects, purpura and other haemorrhagic conditions). Joinpoint regression was used for trend analysis, with data stratified on the basis of sex, race, state, place of death, and census region. Results: From 1999 to 2023, a total of 418,395 deaths related to coagulation defects were reported among older adults aged 25 and above. Overall, the age-adjusted mortality rate (AAMR) decreased from 7.89 per 100,000 population in 1999 to 7.26 in 2018 (APC: [-0.48; 95% CI: -0.30 to -0.66]), followed by a significant rise from 7.26 in 2018 to 10.03 in 2021 (APC: [12.64; 95% CI: 6.71 to 18.90]). And, dropped again in 2023 to 8.58 [APC:-5.82; 95%: -10.60 to -0.80]. Older men had a higher AAMR compared to older women (8.52 vs. 6.36), with respective APCs of 0.45 [95% CI: -0.50 to 0.45] for men and 0.66 [95% CI: -0.05 to 1.38] for women. Among racial and ethnic groups, African Americans had the highest AAMR (10.31). Regionally, the South reported the highest AAMR (7.88). Micropolitan (non-metropolitan) areas had a higher AAMR (7.94) compared to large metropolitan areas (7.41). State-level AAMRs ranged from 5.42 in Illinois to 15.04 in South Dakota. States in the top 90th percentile included North Dakota (12.93), South Carolina (13.36), Colorado (13.37), and Wyoming (12.82) with rates approximately double those in the bottom 10th percentile. Notably, mortality was more frequent in medical facilities (69.62%) than at home (14.51%). Conclusion: Overall, US adults aged 25 and more saw a modest decline in mortality secondary to coagulation defects mortality from 1999 to 2018, a sharp rise during 2018–2021, and a subsequent drop by 2023. Persistent disparities—higher rates in men, African Americans, and in the South and micropolitan areas—alongside most deaths in medical facilities, sheds light on the need for targeted public health interventions.