Temporal trends in aplastic anemia mortality across u.S. regions (1999–2020)

Abstract Introduction: Aplastic anaemia is a life-threatening, rare disease with high rate mortality. Even though the pathophysiology of the condition is inherently multifactorial, the heterogeneity of the regional mortality trends has not been explored in a systematic manner. This study aims to describe mortality patterns related to aplastic anaemia over time across United States from 1999-2020 Methods: This study utilized the CDC WONDER database to investigate mortality trends with regard to aplastic anaemia (ICD-10 D61.9) across the United States in the period between 1999 and 2020. Age-adjusted mortality rates (AMRs) were computed, and Joinpoint regression was used to estimate Annual Percent Change (APC) and the Average Annual Percent Change (AAPC) on various stratification levels, including geographic region, sex, race, urbanization, and age. Results: Between 1999 and 2020, there were 1,463,046 deaths attributed to aplastic anaemia in adults aged 25 and older. The Age adjusted mortality rate (AAMR) increased slightly from 2.505 in 1999 to 2.61 in 2020 , with an Annual Average Percent Change (AAPC 0.2106, 95% CL -0.3184, 0.7425) . Regionally, the Midwest exhibited the highest AAMR increasing from 2.673 in 1999 to 2.867 in 2020 showing a rising trend (AAPC: 0.6467 95% CI ;0.0385, 1.3366).The South and West regions had more stable trends with minor fluctuations in mortality. In terms of gender, males had higher mortality rates than females with AAMR 3.273 in 1999 to 3.186 ( APC 0.0985 95% CL; -1.0301, 0.842).Racial disparities were observed, with non-Hispanic Black individuals experiencing slightly higher mortality AAMR: 2.981 in 1999 decreasing to 2.65 in 2020 ( AAPC -0.1955 95% CL; -0.9263, 0.5407). Whereas, non-Hispanic White attributed increases in AAMR in to 2.635 in 2020 from 2.452 in 1999 (AAPC 0.3466 95% Cl ;-0.2434, 0.94) individuals . These differences reflect broader socio-economic and healthcare gaps, but they were minor in magnitude. Rural areas exhibited a higher mortality burden than urban areas from 2.842 in 1999 to 3.255 in 2020 (AAPC 0.9962 95% Cl;0.1606, 1.8387), indicating a rising trend. In contrast, urban areas showed a much lower AAPC (0.1612 95% Cl;-0.3622, 0.6874), with no significant trend in mortality. Among age groups 55-64 years had the highest increase AAPC (1.061 Cl 95%;0.0276, 2.105), while 35-44 years age group declined AAPC (-0.4241 95% Cl;-1.5753, 0.7407). The highest crude mortality rate was in the 75 to 84 years age group (10.503 in 1999,10.954 in 2020) and the lowest in 25-34 years age group (0.321in 1999,0.258 in 2020). Conclusion: The empirical data have shown that the mortality rate of aplastic anaemia remained rather constant in the recent years with a slight, insignificant increase. In the Midwest region, which is characterised by even greater health disparities, the highest rate is recorded. These disparities are fuelled by gender, racial, and rural-urban differences and reflect the need to develop customized, public health interventions. There were no significant gender differences in mortality trajectories according to empirical evidence, but racial-ethnic minorities, especially non-Hispanic Blacks, showed an increased mortality rate. Meanwhile, in rural areas, the rate of mortality is significantly growing, thus highlighting the necessity of reducing the current healthcare disparities in access to care. The modern public-health problem would require a reconsideration of the current strategies pursued, with a greater emphasis on interventions targeted at building adequate healthcare infrastructure in the underserved areas and oriented at improving equal access to the targeted services.