Persistent and emerging racial gaps in mortality from malignant hematologic malignancies, 2018–2023

Abstract Background Malignant hematologic malignancies, encompassing leukemia, lymphoma, and myeloma, remain a significant cause of cancer-related mortality in the United States. Despite therapeutic advances, persistent racial disparities continue to influence outcomes. While long-term disparities have been documented, contemporary mortality trends across racial groups remain less defined, particularly in the United States. Methods We conducted a retrospective, population-based study using the CDC WONDER Multiple Cause of Death database (Underlying Cause of Death, 2018–2023) to assess mortality attributable to malignant hematologic malignancies (ICD-10 codes C81–C96). Age-adjusted mortality rates (AAMRs) per 100,000 population were extracted for each year, stratified by 15 detailed race categories. Age adjustment was performed using the 2000 U.S. standard population. Temporal mortality trends were assessed using Joinpoint regression modeling to estimate annual percent change (APC) and average annual percent change (AAPC), each with 95% confidence intervals (CIs). Results: In 2023, a total of 343,883 deaths from malignant hematologic malignancies were reported. From 2018 to 2023, deaths decreased from 57,609 to 56,738, corresponding to an average annual percent change (AAPC) of –0.3%. By subtype, mortality trends showed declines for Hodgkin lymphoma (–0.33%), Non-Hodgkin lymphoma (–0.30%), multiple myeloma and malignant plasma cell neoplasms (–1.15%), lymphoid leukemia (–0.04%), and monocytic leukemia (–5.42%). In contrast, malignant immunoproliferative disease (+2.48%) and myeloid leukemia (+0.89%) demonstrated increases. Racial trends revealed modest mortality declines among White (–0.38%) and Black (–0.44%) populations, with more pronounced reductions in American Indian or Alaska Native (–2.13%), Japanese (–1.96%), Hawaiian (–5.34%), Guamanian (–5.90%), and Other Pacific Islander (–3.99%) groups. Mortality increased in several Asian subgroups, including Asian Indian (+3.76%), Korean (+3.65%), Vietnamese (+2.69%), Other Asian (+5.12%), Filipino (+1.05%), and Samoan populations (+13.90%). Chinese (+0.96%) and individuals identifying as More than one race (+3.41%) also showed increases. Regional analysis highlighted that Black populations experienced declines in the Northeast (–1.21%), Midwest (–1.71%), and South (–0.21%), but an increase in the West (+1.89%). Asian Indian populations exhibited marked increases in the South (+6.49%) and Midwest (+4.99%), with smaller rises in the West (+4.03%) and Northeast (+0.27%). Other Asian subgroups, such as Chinese and Korean populations, showed mixed patterns, with declines in Eastern regions and increases in the West. American Indian or Alaska Native populations declined in the Midwest (–2.38%) and West (–3.77%), but rose slightly in the South (+0.45%). Urbanization patterns showed that American Indian or Alaska Native populations declined sharply in large fringe (–8.05%) and medium metros (–6.84%) but increased in large central metros (+4.7%). Asian Indian populations demonstrated consistent increases across most urban categories, highest in large fringe (+5.66%) and medium metros (+5.51%). Sex-specific analysis showed American Indian or Alaska Native populations had similar declines among males (–2.19%) and females (–2.05%). In contrast, Asian Indian males (+4.6%) and females (+2.51%) exhibited rising mortality, with a greater increase among males. Chinese males (+2.88%) experienced rising mortality, whereas Chinese females declined (–1.34%). Filipino females showed marked increases (+3.46%) compared to declines in males (–1.36%). Native Hawaiian females demonstrated the most significant increase (+9.09%), in contrast to declines in males (–1.47%). Conclusion: Overall mortality from malignant hematologic malignancies declined modestly; however, the magnitude and direction of change varied substantially across racial groups. While White, Black, and several Pacific Islander populations experienced reductions, mortality increased among multiple Asian subgroups, particularly Asian Indian, Korean, Vietnamese, Samoan, and Other Asian populations. These patterns highlight that survival gains are not equitably distributed, with persistent and emerging racial disparities requiring focused, population-specific strategies to address unequal cancer outcomes.