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US death rates from myeloproliferative neoplasms, and implications for cancer surveillance
1Formerly with the Connecticut Tumor Registry, Connecticut Department of Public Health, Hartford, Connecticut, USA. appoled7@yahoo.com
Abstract:
Myeloproliferative neoplasms (MPN) may contribute to death from other causes due to complications and sequelae of MPN or its treatment. The present study found that the US death rate for MPN (polycythemia vera, essential thrombocythemia/thrombocytosis, and "chronic myeloproliferative disease") in 2005-2006 was twice as high using all causes of the death on the death certificate (6,488 deaths, age-standardized rate 1.06 per 100,000 per year) vs only the underlying cause (3,303 deaths, age-standardized rate 0.54 per 100,000 per year). This finding was consistent by age, gender, race (African American/black and white) and Hispanic ethnicity. Thus, surveillance of trends in MPN-related mortality rates in the population needs to take into account all causes of death on the death certificate, because MPN contributes to death from other causes such as thrombosis. MPN is a major cause of splanchnic vein thrombosis (SVT), and under-ascertainment of MPN-related deaths was suggested by the small proportion (3%) of all 848 US deaths in 2005-2006 with SVT coded as any cause of death that also had MPN coded. Increased clinical testing of peripheral blood for specific acquired genetic mutations, known since 2005 as being common in certain MPN and also in SVT, could lead to increased numbers of deaths certified as MPN-related and also incident cases of MPN reported to central cancer registries.
Insights
Myeloproliferative neoplasms (MPN) deaths are underestimated. Counting all causes of death on certificates, not just the underlying cause, reveals MPN mortality rates are twice as high, highlighting MPN
Area of Science:
- Hematology
- Oncology
- Public Health
Background:
- Myeloproliferative neoplasms (MPN) can lead to mortality through complications or treatment side effects.
- Accurate death ascertainment is crucial for understanding MPN's population impact.
Purpose of the Study:
- To determine the true US mortality rate for MPN (polycythemia vera, essential thrombocythemia/thrombocytosis, chronic myeloproliferative disease) between 2005-2006.
- To assess the impact of using all listed causes of death versus only the underlying cause on death certificates for MPN mortality figures.
Main Methods:
- Analysis of US death certificate data from 2005-2006.
- Comparison of age-standardized mortality rates for MPN using all listed causes versus only the underlying cause of death.
- Examination of MPN's contribution to splanchnic vein thrombosis (SVT) mortality.
Main Results:
- The US death rate for MPN was twice as high when considering all causes listed on death certificates (1.06 per 100,000) compared to only the underlying cause (0.54 per 100,000).
- This discrepancy was consistent across various demographics including age, gender, race, and ethnicity.
- MPN is a significant cause of SVT, yet only 3% of SVT deaths in the study period also listed MPN, indicating under-ascertainment.
Conclusions:
- Current surveillance of MPN mortality likely underestimates the true burden due to the practice of relying solely on the underlying cause of death.
- MPN contributes to mortality from other conditions like thrombosis, necessitating the inclusion of all death certificate causes for accurate tracking.
- Increased genetic testing for MPN and SVT may improve future death certification and case reporting accuracy.
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