Deaths Due to Second Hematological Malignancies Following Gastrointestinal Cancers: A Nationwide 25-Year Cross-Sectional Analysis

Shree Rath; Amar Lal; Ahmed Hasan; Muhammad Ali; Iffat Ambreen Magsi; Umama Alam; Mishaim Khan

doi:10.15403/jgld-6802

Authors

Shree Rath All India Institute of Medical Sciences Bhubaneswar, India
Amar Lal Assistant Professor, Penn State Health Milton S Hershey Medical Center, Hershey, PA, USA
Ahmed Hasan Jinnah Sindh Medical University, Karachi, Pakistan
Muhammad Ali Dow International Medical College, Karachi, Pakistan
Iffat Ambreen Magsi Shaheed Mohtarma Benazir Bhutto Medical College, Sindh, Pakistan
Umama Alam Khyber Medical College, Peshawar, Pakistan
Mishaim Khan FMH College of Medicine and Dentistry, Lahore, Pakistan

DOI:

https://doi.org/10.15403/jgld-6802

Keywords:

epidemiology, secondary malignancy, gastrointestinal malignancies, public health, racial disparities, rural−urban gap

Abstract

Background and Aims: Cancer survivors, particularly those treated for gastrointestinal (GI) cancers, face an elevated risk of developing secondary hematological malignancies (SHMs) such as leukemia, lymphoma, and myelodysplastic syndromes. This study aimed to analyze national trends in mortality due to SHMs among older adults with GI malignancies over 25 years.

Methods: We conducted a descriptive analysis of SHM-related deaths in patients with GI malignancies using CDC-WONDER death certificate data from 1999 to 2023. Age-adjusted mortality rates (AAMRs) were calculated, and annual percent change (APC) and average annual percent change (APC) were determined using the JoinPoint Regression to identify significant temporal changes.

Results: A total of 22,668 deaths occurred due to hematological and GI malignancies. The AAMR increased from 21.88 in 1999 to 25.55 in 2023. Significant trends were observed, with an initial decline from 1999 to 2017, followed by a sharp increase from 2017 to 2023 (AAPC: 5.49; 95%CI: 3.63–8.61). Males exhibited a higher average AAMR compared to females. Crude mortality rates increased with age, with the lowest in the 65–74 age group and the highest in the 85+ age group. Non-Hispanic Whites had the highest average AAMR (22.35), followed by Blacks (18.84). Non-metropolitan areas consistently had higher AAMRs (23.37; 95%CI: 19.89–26.85) compared to metropolitan areas (19.98; 95%CI: 18.46–21.50).

Conclusion: This study highlighted significant temporal trends in SHM-related mortality among GI-cancer patients aged 65 and older. The increasing mortality rates, particularly post-2017, call for targeted interventions to address disparities and improve outcomes for vulnerable populations.