Myelodysplastic syndrome incidence, transfusion dependence, health care use, and complications: an Australian population-based study 1998 to 2008

BACKGROUND: We investigated the incidence of myelodysplasia (MDS), its transfusion requirements, and complications of red blood cell (RBC) transfusion dependence (TD) using a hospitalization data set from a population of 5.3 million. STUDY DESIGN AND METHODS: This study was a retrospective cohort analysis of a population data set that captures diagnostic and procedure data on all hospitalizations from more than 300 hospitals within the Australian state of Victoria from 1998 to 2008. RESULTS: There were 3149 incident cases of MDS. The age-standardized incidence rate was higher than reported from local cancer registries (for 2007 9.6 per 100,000 [95% confidence interval {CI}, 9.2-10.0] vs. 4.8). Median age was 79 years, 56.3% were males, and 34.6% were TD-MDS. Overall number of hospitalizations with transfusion increased over the study period, but not median transfusion episodes per patient. TD-MDS was associated with new diagnoses of congestive heart failure (CHF; incident rate ratio [IRR], 1.92; 95% CI, 1.41-2.60), but not diabetes (IRR, 1.29; 95% CI, 0.54-3.04) or liver disease (IRR, 1.91; 95% CI, 0.63-5.78). TD-MDS was associated with bacterial (IRR, 1.75; 95% CI, 1.37-2.24) and fungal infections (IRR, 3.13; 95% CI, 1.70-5.75) and leukemia (relative risk [RR], 1.42; 95% CI, 1.07-1.88) and sepsis as cause of death (RR, 1.23; 95% CI, 1.03-1.47) but not CHF (RR, 0.97; 95% CI, 0.71-1.32). CONCLUSION: There was a higher incidence of MDS compared with that reported by cancer registries. Overall hospitalizations increased over the study period with no change in transfusion episodes per patient. There were more incident cases of CHF and infections in TD-MDS; however, CHF was not a more frequent cause of death.