TRENDS IN MYELODYSPLASTIC SYNDROMES-RELATED MORTALITY IN BRAZIL FROM 2014 TO 2023

Abstract

Objectives: This study aims to analyze the epidemiology of myelodysplastic syndromes (MDS)-related deaths among Brazilian patients, thereby helping to understand the disorder's behavior and to formulate public health strategies to mitigate its impact. Material and methods: This is a retrospective, observational study with data from the Secretariat of Health Surveillance (SVS). Deaths from January 2014 to December 2023 identified as related to MDS (ICD-10 D46) were included, categorized by sex, age, race, location and calendar year. Statistical analysis was performed considering absolute and relative frequencies. Results: In total, 9,659 deaths related to MDS occurred in Brazil during the period, meaning an average of around 966 deaths per year. Males accounted for 5,082 (52.6%) deaths, while females accounted for 4,576 (47.4%). The number of reported deaths increased with age, from 56 deaths in patients aged 01-09 years old to 2,687 deaths in patients aged 70-79 and 4,045 deaths in patients aged 80+; overall, patients under 60 years old represented 14% of all deaths, while 86% were patients 60+ years old. The white population was the most affected, with 6,498 (63.7%) deaths; 2,284 (23.6%) were brown; 471 (4.9%) were black; and 406 (4.2%) were yellow, indigenous or did not have their race recorded. Regarding location, 5,271 (54.6%) deaths occurred in the Southeast, 1,752 (18.1%) in the South, 1,692 (17.5%) in the Northeast, 592 (6.1%) in the Central-West and 352 (3.6%) in the North. The year with the most deaths was 2023 with 1,120 (15.9% above average), whilst the year with the least was 2015 with 835 (13.6% beneath average). Discussion: The slight male predominance observed, which is greater relative to the Brazilian male/female proportion (48.5/51.5 in 2022 according to IBGE), might be related to genetic and hormonal differences and to environmental exposure to risk factors such as smoking, which may lead to worse survival. The age range reveals that MDS are significantly more prevalent in the elderly, likely due to genetic mutations and age-related changes in bone marrow that are more common with aging. Comorbities and a weakened immune system may as well contribute to a higher death rate in older patients with MDS. The preponderance of reported deaths among whites is possibly due to genetic predisposition or to disparities in socioeconomic backgrounds and access to healthcare services, causing the white population to be more assertively diagnosed, as MDS diagnosis often requires specialized services. This might also explain the regional discrepancies in deaths relative to the population, with proportionally more deaths in the South and Southeast and fewer in the Northeast, North and Central-West, as there is a higher rate of whites and greater access to specialized medical services in the South and Southeast. Yearly mortality remained reasonably stable, with a subtle increase that might be associated with population aging or improved diagnosis capability. Conclusion: The data demonstrates a clear relation between age and mortality, with a significant number of deaths among the elderly population. This highlights the necessity for the development of new treatments that might reduce the risk associated with MDS in older individuals. The higher occurrence of reported deaths in regions and demographics with greater socioeconomic status and access to healthcare exhibits the need for public health strategies to address these disparities.