Mortality trends in patients with multiple myeloma and renal failure in the United States (1999–2020): A CDC WONDER database analysis.

e19571Background: Renal failure (RF) leads to significant treatment challenges, morbidity, and cancer-related mortality in patients with multiple myeloma (MM). Despite recent advances, outcomes for MM patients with RF remain poor, and mortality disparities in this population remain elusive. This study estimated mortality trends of patients with MM and RF. Methods: Mortality data from the CDC Wide-ranging Online Data for Epidemiologic Research (WONDER) database (1999–2020) were analyzed to evaluate age-adjusted mortality rates (AAMR) per 100, 000 for MM and RF using the International Classification of Diseases, 10th Revision (ICD-10) codes. Patients aged 25 years and above were included. Joinpoint regression analysis was employed to calculate the Annual Percent Change (APC) and detect significant trend shifts. The data were further stratified by age, sex, urban-rural classification, census regions, states, and place of death. Results: A total of 52, 116 deaths were attributed to RF in patients with MM, with 56% occurring within medical facilities and only 12% in nursing or long-term care settings. For females, AAMR declined from 1.0 (1999) to 0.62 per 100, 000 (2020; APC: -3.64%; p<0.05). Males experienced an initial increase from 1.71 in 1999 to a peak in 2005 (APC: +1.65%; p<0.05) before declining serially to 1.15 in 2020. While AAMR persisted at lower rates (0.26-0.20) among younger patients (aged 25-65; n=10, 794) across the two decades, it dropped significantly in the older cohort (>65; n=41, 322) [4.04 in 1999 to 1.95 in 2020]. AAMRs declined more steeply in urban areas compared to rural regions. Large central metro areas, which had the highest AAMR in 1999, experienced the sharpest decline after 2003 (APC: -3.42%). Other metro areas showed steady declines (APCs: -2.74% to -3.14%), while rural micropolitan and noncore regions had slower reductions (APCs: -2.16% and -2.06%). The Southeast region, including states such as Mississippi (AAMR: 1.3) and South Carolina (AAMR: 1.4), had the highest AAMRs, while the District of Columbia recorded the highest state-level AAMR (AAMR: 1.9). The states with the lowest AAMRs were Arizona (AAMR: 0.7), Florida (AAMR: 0.8), and Montana (AAMR: 0.8), indicating better outcomes in these regions. Conclusions: Mortality due to MM and RF has substantially declined due to advancements in the MM therapeutic landscape, mainly with the introduction of novel agents and cellular therapy. Our results provide critical data to inform resource allocation, homogenize gender and urban/rural disparities, and optimize utilization of tertiary care facilities to improve outcomes. The high proportion of deaths inside medical facilities highlights the underutilization of palliative care, which contributes to a substantial healthcare burden.