Trends in mortality due to aplastic anemia in the United States, 1999-2020: a center for disease control wonder analysis

BACKGROUND: Acquired aplastic anemia is a rare, life-threatening hematologic disorder characterized by immune-mediated bone marrow failure. Despite therapeutic advancements that have increased survival, evaluating contemporary mortality trends in the United States remains important to inform clinical practice and health policy. OBJECTIVES: This study examined aplastic anemia-related mortality trends, demographic disparities, and geographic variation among United States adults from 1999 to 2020. METHODS: Death certificate data from the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research database were analyzed for adults aged 25 years and older. Age-adjusted mortality rates per 100,000 persons and annual percent changes were calculated across years, sex, race, ethnicity, and geographic regions. Place of death and state-level social vulnerability index correlations were also evaluated. RESULTS: Aplastic anemia was recorded in 107,975 deaths from 1999 to 2020. The national age-adjusted mortality rate decreased initially from 1999 to 2002, remained stable until 2015, and increased through 2020. Men consistently demonstrated higher age-adjusted mortality rates than women. Non-Hispanic Black or African American individuals had the highest mortality rates among racial groups. Mortality was higher in non-metropolitan areas and the Midwest region. Mortality varied widely across states, whereas state-level social vulnerability was not associated with mortality rates. CONCLUSIONS: Following a period of stability, aplastic anemia-related mortality has increased in the United States since 2015. Disparities persist across sex, race, urbanization, and geographical region.