Divergent Mortality Trends in Hematologic Malignancies and Diffuse Non–Hodgkin Lymphoma Across the United States: A CDC WONDER Database Analysis from 1999 to 2023

Background: While overall hematologic and lymphoid malignancy (HLM) mortality has declined in the US, significant disparities persist across subtypes and demographic groups. This study characterizes 24-year trends in HLM and diffuse non-Hodgkin lymphoma (DNHL) mortality, quantifying inequities through advanced segmentation modeling. Methods: Using CDC WONDER mortality data (1999–2023), we performed Joinpoint regression analyses to calculate annual percent changes (APC) and average annual percent changes (AAPC) in age-adjusted mortality rates (AAMR). Stratification by sex, race/ethnicity, age, region, and urbanicity identified high-risk populations. Results • Divergent national trends: HLM mortality decreased (AAPC = -1.74%; 95% CI: -1.80 to -1.68) despite +1.74% absolute death increase. DNHL mortality surged (AAPC = +2.64%; 95% CI: 1.19 to 4.11) with +177.59% death rise. • Critical disparities: Age: Young adults (25–34y) showed HLM mortality reversal post-2020 (APC +1.17%, P ≥0.05) vs steep DNHL rise in ≥85y (AAPC= +4.41%；95% CI:1.75 to 7.14). Race: Hispanic and NH-Other populations experienced 107–128% HLM death increases alongside 3.41–3.90% DNHL AAPC rises. Geography: DNHL mortality doubled in Western states (e.g., California: 2008–2011 APC = +15.37%; 95% CI: -2.12 to 35.99) while HLM declines lagged in Southern regions. l Novel inflection points: Nationwide DNHL mortality shifted from decline (1999–2008 APC = -3.83%; 95% CI: -4.92 to -2.73) to sharp increase (2008–2011 APC = +16.79%; 95% CI: 3.97 to 31.18). Urban areas demonstrated accelerated HLM declines post-2012 (APC = -2.14%; 95% CI: -2.34 to -1.94). Conclusion: Substantial gains in HLM mortality mask worsening disparities, particularly among racial minorities and older adults. The alarming rise in DNHL mortality—characterized by distinct inflection points and geographic hotspots—signals an urgent need for targeted interventions.