Non-Hodgkin lymphoma mortality disparities across different sexes, races, and geographic locations

Background: Non-Hodgkin lymphoma (NHL) is one of the common hematological cancers in the United States (U.S.), accounting for 4% of new cancer cases in 2023. The mortality rate of NHL is the sixth highest among all cancers in the U.S. Our study aimed to examine the trends in NHL mortality and assess the mortality disparities among different sexes, ages, races, geographic locations, and urbanization levels.

Methods: Our population-based cross-sectional study analyzed death certificate data from the Centers for Disease Control and Prevention’s Wide-Ranging Online Data for Epidemiologic Research (CDC WONDER) U.S. from 1999 to 2020 to determine the longitudinal trends of NHL mortality among the U.S. population aged ≥ 15 years. NHL (ICD-10 C82-85) was listed as the underlying cause of death. Age-adjusted mortality rates (AAMRs) per 100,000 individuals were calculated and joinpoint trend analysis were performed to determine the average annual percent change (AAPC) in AAMR trends.

Results: From 1999 to 2020, NHL accounted for 457,143 deaths in the United States, of which 54% are men and 46% are women. Excluding unspecified NHL, there were 132,288 (n=132,288/155,957, 84.8%) B cell NHL deaths and 23,669 (n=23,669/155,957, 15.2%) T cell NHL deaths. Overall, the AAMR of NHL decreased from 10.59 (95% CI, 10.46-10.73) in 1999 to 6.21 (95% CI,6.13-6.30) in 2020 with the AAPC of -2.55 (95% CI, -2.63, -2.46). Men had a higher AAMR than women (10.10 [95% CI, 10.06-10.14] vs. 6.29 [95% CI, 6.27-6.32]). Non-Hispanic Whites recorded the highest AAMR (8.43 [95% CI, 8.40-8.45]), followed by non-Hispanic Blacks (5.71 [95% CI, 5.64-5.77]), Hispanics (6.32 [95% CI, 6.25 – 6.40]), American Indians (5.31 [95% CI, 5.04 – 5.58]), and Asians (5.10 [95% CI, 5.00 – 5.19]). Death from NHL was the most common in patients aged 75 years and above (52.50%), followed by patients aged 55-74 years (37.49%) and patients aged 15-54 years (10.41%). Those who lived in the Midwest region had the highest AAMR (8.60 [95% CI, 8.55-8.65], followed by the Northeast region (7.99 [95% CI, 7.94 – 8.05]), the South region (7.73 [95% CI, 7.70 – 7.77]), and the West region (7.58 [95% CI, 7.54 – 7.63]) . The rural population has a higher AAMR compared to the urban population (8.35 [95% CI, 8.29-8.41] vs. 7.86 [95% CI, 7.83 – 7.88]).

Conclusions: NHL mortality has declined over the last two decades. The higher mortality rates existed among men, non-Hispanic White individuals, and the rural population warrant targeted intervention to address the mortality disparities.

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