Trends and Disparities in Acute Lymphoblastic Leukemia-Related Mortality in the United States from 1999 to 2020

Objectives:The incidence of acute lymphoblastic leukemia (ALL) shows a bimodal distribution, with the first peak in children under 10 years old and the second in adults. It is imperative to understand disparities in ALL-related mortality.Methods:ALL-related mortality trends in the United States from 1999 to 2020 were studied by extracting age-adjusted mortality rates (AAMRs) from the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research database. Changes in AAMR were evaluated by calculating annual percentage change (APC) and average APC using Joinpoint regression.Results:A total of 35,056 ALL-related deaths were reported. The AAMR declined from 1999 to 2020 (APC: -0.65). Men exhibited a higher AAMR (0.59) than women (0.43). Hispanic or Latinos exhibited the highest AAMR (0.75), followed by non-Hispanic (NH) whites (0.47), NH black or African Americans (0.37), and NH Asian or Pacific Islanders (0.35). Among census regions, the West was observed to have the highest AAMR (0.59), followed by the South (0.49), the Midwest (0.47), and the Northeast (0.45). California had the highest AAMR (0.64), while the District of Columbia had the lowest (0.40). Stratification by urbanization revealed a higher overall AAMR in rural areas (0.52) than in urban areas (0.48). A majority of the deaths occurred in medical facilities (63.52%).Conclusions:Even though a decrease was observed in ALL-related mortality in the United States from 1999 to 2020, disparities were identified in trends stratified by sex, race, census regions, and urbanization. It is essential to direct efforts towards high-risk populations to ensure a decrease in ALL-related mortality across the board.