Background: Chronic myeloid leukemia (CML) accounts for 15% of adult leukemias in the United States (U.S.). The introduction of tyrosine kinase inhibitors (TKIs) has markedly improved survival, transforming CML into a chronic, treatment-responsive disease for many patients. However, it remains unclear whether these survival gains have been equitably distributed across different geographic and sociodemographic populations nationally. This study aimed to evaluate trends in CML-related mortality over two decades, stratified by race, sex, region, and urbanization level.

Methods: The CDC WONDER Multiple Cause of Death database was queried for deaths with an underlying cause of CML (ICD-10 code C92.1) from 1999–2020. Age-adjusted mortality rates (AAMR) per 100,000 persons were calculated using the 2000 U.S. standard population and stratified by sex, race, and 2013 National Center for Health Statistics (NCHS) urbanization classification. Mean crude mortality rates by state were calculated, and states were grouped by U.S. census region. Joinpoint regression was used to calculate annual percent change (APC), with statistical significance defined as p<0.05.

Results: From 1999–2020, there were 17,028 CML-related deaths recorded in the U.S., with an average of 774 deaths per year. The national AAMR declined significantly over time at an average rate of 2.55% per year (p=0.0004). Both sexes experienced declines in mortality rates, with a slightly steeper reduction observed in females (APC −2.67%, p=0.0004) than males (APC −2.41%, p=0.0007). By race, White individuals had the highest AAMR throughout the study period, but also showed a significant decline (APC −2.85%, p=0.0001). Other racial groups had event counts that were too low for stable AAMR estimates. When stratified by geography and urbanization, rural communities consistently experienced higher CML-related mortality compared to urban areas, despite overall declines. Micropolitan (0.50) and noncore rural (0.49) counties exhibited the highest mean AAMRs, compared to medium metro areas (0.47). Geographically, the South had the highest mean crude mortality rate, driven by Florida (0.61) and Tennessee (0.61). The Midwest also showed elevated rates, with Missouri (0.57) and Ohio (0.56) among the highest. In the Northeast, Pennsylvania (0.55) led the region. While all regions demonstrated significant declines, the South experienced the slowest rate of improvement (APC −2.1%, p<0.05), whereas the West showed the steepest decline (APC −2.9%, p<0.05). Temporary plateaus or slight increases in mortality were observed in 2013–2014 and 2019–2020.

Conclusion: This study demonstrates a sustained national decline in age-adjusted CML-related mortality over two decades. However, disparities persist as mortality reductions were not uniformly distributed across populations. Higher mortality rates were observed in rural areas, the Southern region, and among White individuals. Slower declines were observed in males. These findings may reflect differences in healthcare access, socioeconomic factors, and treatment adherence, along with possible sex-related differences in disease profile. We also underscore the need for more inclusive datasets on underrepresented populations, ongoing surveillance, and targeted interventions to help bridge the gaps in ensuring equitable improvements in CML outcomes nationwide.

This content is only available as a PDF.
2025
Sign in via your Institution