Fatima, Ayesha

Abstract Background: Chronic Lymphocytic Leukemia (CLL) is the most prevalent leukemia among adults in Western populations, disproportionately affecting the elderly, with a median age at diagnosis of approximately 70 years. Over the past two decades, significant advancements in therapeutic options, including Bruton tyrosine kinase (BTK) inhibitors, BCL-2 antagonists, and monoclonal antibodies, have improved clinical outcomes. However, despite these advances, limited data exist on long-term mortality trends and disparities in CLL outcomes among older adults in the United States. Understanding such patterns is critical to guiding geriatric oncology care, identifying gaps in healthcare delivery, and informing public health strategies. Methods: We conducted a population-based analysis using the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research (CDC WONDER) Underlying Cause-of-Death database. We identified all deaths among individuals aged ≥65 years from 1999 to 2020 in which CLL (ICD-10 code C91.1) was listed as the underlying cause. Mortality data were stratified by sex, age group (65–74, 75–84, ≥85), U.S. Census region, urban-rural classification, state, and place of death. We calculated crude mortality rates (CMRs) and age-adjusted mortality rates (AAMRs) per 100,000 persons, standardized to the U.S. 2000 population. Joinpoint regression analysis was used to assess temporal trends in AAMRs and compute annual percent changes (APCs) and average annual percent changes (AAPCs), with statistical significance set at p<0.05. Results: Between 1999 and 2020, a total of 85,371 CLL-related deaths occurred among U.S. adults aged ≥65 years. The overall AAMR declined from 11.18 per 100,000 in 1999 to 7.75 in 2020, reflecting a significant downward trend (AAPC: -1.86%; 95% CI: -2.18 to -1.54; p<0.0001). Men consistently exhibited higher mortality rates (AAMR: 13.48) than women (AAMR: 6.45), though the mortality decline was more pronounced among women (AAPC: -2.10% vs. -1.65%, respectively; both p<0.0001). Regional disparities were evident, with the Midwest reporting the highest AAMR (10.63), and the West the lowest (8.71). Urbanization analysis revealed higher mortality in non-metropolitan areas (AAMR: 10.33) than metropolitan ones (AAMR: 9.08), though both experienced significant declines over time. Age-stratified analysis showed the steepest declines in the 65–74 age group (AAPC: -3.91%; p<0.0001), followed by those aged 75–84 years (AAPC: -1.96%) and ≥85 years (AAPC: -0.25%). States with the highest mortality included Minnesota, Iowa, and South Dakota, while Hawaii, Nevada, and New Mexico had the lowest. Most deaths occurred in medical facilities (43.8%), followed by home (26.7%), nursing homes/long-term care (19.5%), and hospice (5.6%). Conclusion: CLL-related mortality among the U.S. geriatric population declined significantly between 1999 and 2020, likely reflecting the impact of therapeutic innovations and improved disease management. However, substantial disparities persist across sex, age, region, urbanization, and state-level subgroups. These findings underscore the importance of equitable access to modern CLL treatments and the need for targeted interventions to reduce mortality in high-risk, underserved older populations. Efforts to close these gaps will be essential in optimizing outcomes in the era of personalized cancer care for aging Americans.

ABSTRACT Background Lung cancer (LC) and respiratory failure (RF) are leading causes of adult mortality worldwide. Analyzing long‐term mortality trends across demographic, racial, geographic, and socioeconomic groups is essential to address disparities and enhance outcomes. This study investigates US national mortality patterns for LC and RF from 1999 to 2023, focusing on changes in age‐adjusted mortality rates (AAMRs) and key disparities. Methods Mortality data from the CDC WONDER database (1999–2023) for adults aged 25+ with LC (ICD‐10: C34) or RF (ICD‐10: J96) were analyzed. AAMRs per 100,000 were calculated, stratified by gender, race/ethnicity, region, state, and urban–rural status. Temporal trends were assessed using Joinpoint regression to estimate annual percent changes (APCs) with 95% confidence intervals (CIs), with significance at p < 0.05. Results Over 1999–2023, 456,325 deaths from LC and RF were recorded. AAMRs declined from 1999 to 2010 (APC = −1.2, 95% CI: −1.6 to −0.9) but rose from 2010 to 2023 (APC = 1.4, 95% CI: 1.1–1.7). Men's AAMRs steadily decreased, whereas women's dropped initially, then increased from 2011 to 2023 (APC = 2.0, 95% CI: 1.7 to 2.5). Non‐Hispanic Whites saw a sharp AAMR rise from 2014 to 2017 (APC = 2.7, 95% CI: 0.9 to 3.3), with other racial/ethnic groups showing mixed trends. Regionally, the Northeast had the highest AAMRs (8.6, 95% CI: 8.5 to 8.7), and the Midwest the lowest (7.1, 95% CI: 7.0 to 7.1). Metropolitan areas saw increases post‐2006, whereas nonmetropolitan areas rose after 2009 (APC = 2.3, 95% CI: 1.8–3.1). Mississippi had the highest state AAMR (14.0, 95% CI: 13.7–14.4), Wisconsin the lowest (3.7, 95% CI: 3.5–3.8). Conclusion LC and RF mortality declined until 2010, then increased, revealing significant disparities. Targeted interventions are critical to address these trends and reduce inequities.

e20629 Background: Lung cancer (LC) and respiratory failure (RF) are major contributors to mortality in adults globally. Understanding long-term mortality trends across demographic, racial, geographic, and socio-economic groups is crucial to addressing disparities and improving outcomes. This study examines national mortality patterns for LC and RF in the United States from 1999 to 2023, providing critical insights into changes over time and identifying key disparities in age-adjusted mortality rates (AAMRs). Methods: A descriptive analysis of mortality data from the CDC WONDER database (1999-2023) identified deaths due to LC (ICD-10 code C34) and RF (ICD-10 code J96) in adults aged 25+. AAMRs per 100,000 population were calculated and stratified by gender, race/ethnicity, region, state, and urban-rural classification. Temporal trends were analyzed with Joinpoint regression to compute APCs and 95% CIs. Statistical significance was set at p<0.05. The study followed STROBE guidelines. Results: From 1999 to 2023, a total of 456,325 adult deaths (age 25-85+) were attributed to Lung cancer and Renal failure. Age-adjusted mortality rates (AAMRs) for lung cancer (LC) and respiratory failure (RF) decreased from 1999 to 2010 (APC = -1.2, 95% CI: -1.6 to -0.9), followed by an increase from 2010 to 2023 (APC = 1.4, 95% CI: 1.1 to 1.7). Gender trends revealed a steady decline for men, while women's Age-Adjusted Mortality Rates (AAMr) initially decreased, then increased from 2011-2023 (APC: 2.0, 95% CI: 1.7 to 2.5). Non-Hispanic White populations experienced a rapid increase in age-adjusted mortality rates from 2014 to 2017 (APC: 2.7; 95% CI: 0.9 to 3.3), while other racial/ethnic groups exhibited varied trends with declines, increases, and stabilizations. Geographically, AAMRs were highest in the Northeast (8.6; 95% CI: 8.5 to 8.7) and lowest in the Midwest (7.1; 95% CI: 7.0 to 7.1). Metropolitan areas saw declining trends until 2006, stabilizing briefly, and increasing thereafter. Non-metropolitan areas experienced notable increases post-2009 (APC = 2.3, 95% CI: 1.8 to 3.1). State-level disparities revealed Mississippi with the highest AAMR (14.0; 95% CI: 13.7 to 14.4) and Wisconsin with the lowest (3.7; 95% CI: 3.5 to 3.8). These findings highlight significant demographic, racial, and geographic variations in LC and RF mortality trends. Conclusions: LC and RF-related mortality rates initially declined from 1999 to 2010 but increased significantly from 2010 onward, with notable demographic, racial, and geographic disparities. These findings highlight the urgent need for targeted interventions and resource allocation to address these rising trends and reduce inequities across vulnerable populations.

e23101 Background: Liver cell carcinoma (LCC) and hepatic failure (HF) are major contributors to global adult mortality. Identifying trends and disparities in LCC and HF-related deaths is critical for addressing public health challenges and guiding prevention strategies. This study examines national trends in LCC and HF-related mortality from 1999 to 2023, with an emphasis on demographic, geographic, and temporal disparities in age-adjusted mortality rates (AAMRs). Methods: Using the CDC WONDER database (1999–2023), this descriptive study identified deaths attributed to LCC (ICD-10 code C22.0) and HF (ICD-10 code K72.9) among adults aged 25 and older. Mortality data were stratified by gender, race/ethnicity, census region, urban-rural classification, and state. Age-adjusted mortality rates (AAMRs) per 1,000,000 individuals were calculated, and trends were analyzed using Joinpoint regression to determine annual percent changes (APCs) with 95% confidence intervals (CIs). Statistical significance was set at p < 0.05, and the study followed STROBE guidelines. Results: From 1999 to 2023, there were 22,963 deaths attributed to LCC and HF (Men: 17,822; Women: 5,141). Overall, AAMRs declined from 1999 to 2007 (APC: -2.4), stabilized between 2007 and 2017 (APC: 0.2), and declined again from 2017 to 2023 (APC: -3.5). Men experienced a steady AAMR decline from 1999 to 2010 (APC: -2.1), followed by stabilization (2010–2017, APC: 0.7), and further decline (2017–2023, APC: -4.4). Women showed a sharp AAMR decrease from 1999 to 2006 (APC: -3.8) and a relatively stable trend thereafter (APC: -0.1). Non-Hispanic Blacks people experienced an overall AAMR decline from 1999 to 2020 (APC: -0.9). Among Non-Hispanic Whites people, AAMRs decreased initially (1999–2006, APC: -2.6), rose slightly (2006–2018, APC: 0.5), and declined further (2018–2020, APC: -7.3). Regional AAMRs varied, with the West having the highest overall AAMR (5.6; 95% CI: 5.4–5.7) and the Midwest the lowest (3.2; 95% CI: 3.1–3.3). Hawaii reported the highest state AAMR (10.3; 95% CI: 8.9–11.6), while Arkansas had the lowest (2.4; 95% CI: 2.0–2.9). Urban-rural disparities revealed a sharper AAMR decline in metropolitan areas (1999–2005, APC: -3.9) and the non-metropolitan areas showed a slight increase (1999–2020, APC: 1.3). Conclusions: LCC and HF-related mortality rates have shown significant declines over the past two decades, with variations across gender, race, and geographic locations. Men and urban populations experienced steeper reductions in AAMRs, while rural populations exhibited slower improvements or slight increases in mortality. These findings highlight the need for targeted public health interventions to address disparities and further reduce LCC and HF-related mortality in vulnerable populations.