Leukemia mortality in Latin America and the United States: A population-based analysis.

Abstract

1597 Background: Leukemia outcomes depend on timely diagnosis, specialized care, and access to effective therapies. Despite improvements in high-income settings, population-level leukemia mortality in Latin America remains incompletely characterized. Comparisons across regions are further complicated by differences in diagnostic capacity and mortality reporting. We compared leukemia mortality across Latin American countries and the United States (US), using U.S. Hispanic individuals as the reference population, to characterize regional disparities, age-specific patterns, and temporal trends. Methods: We conducted a population-based analysis of leukemia mortality using the WHO Mortality Database for 15 countries and U.S. National Vital Statistics/SEER data. The burden of leukemia mortality was assessed from 2008 to 2019. Mortality rate ratios (MRRs) were estimated using Poisson regression. Trends were assessed using Joinpoint regression, and associations with the Human Development Index (HDI) were evaluated using linear regression. Results: Among children (0-19 years), most Latin American countries had significantly higher leukemia mortality than U.S. Hispanic children (MRRs 1.23-3.18), with the highest rates observed in Mexico (2.58/100,000; MRR = 3.18) and Ecuador (2.49/100,000; MRR = 3.06). In contrast, U.S. non-Hispanic White, African American, Asian/Pacific Islander, and American Indian/Alaska Native children had lower mortality than U.S. Hispanic children. Among adults (≥20 years), leukemia mortality patterns were heterogeneous. U.S. non-Hispanic White adults had higher mortality than U.S. Hispanic adults (9.6/100,000; MRR = 1.74), as did higher-HDI Latin American countries, including Uruguay and Costa Rica, whereas most countries demonstrated comparable or lower mortality. Childhood leukemia deaths were dominated by ALL, while adult mortality showed greater subtype heterogeneity, with a predominance of AML, chronic leukemias and a high proportion of deaths coded as leukemia not otherwise specified (NOS). Higher HDI was associated with lower mortality among young adults, but higher reported mortality among elderly adults. Conclusions: Leukemia mortality across Latin America and the US remains highly heterogeneous, with substantial excess mortality among children and older adults in several countries. Age associations with HDI and the high burden of leukemia NOS coding suggest disparities and limitations in diagnostic capacity and registry. Leukemia mortality* and subtype distribution. Population Children Mortality Rate Children MRR Adult Mortality Rate Adults MRR U.S. non-Hispanic White 0.5 0.65 9.6 1.74 Mexico 2.58 3.18 5.76 0.92 Ecuador 2.49 3.06 5.47 0.88 Colombia 2.22 2.5 6.05 0.85 Uruguay 1.31 1.1 7.15 1.35 Costa Rica 1.28 1.05 7.09 1.13 Leukemia subtype Children (%) Adults (%) ALL 50–70 10–20 AML 15–25 25–40 Chronic leukemias <5 20–35 Leukemia NOS 8–40 17–50 *Reference group: U.S. Hispanics.