Abstract

 

Background

Multiple myeloma (MM) outcomes have improved over time; however, less is known about national trends in

nutritional decline near the end of life. We examined malnutrition, cachexia, weight loss, and dysphagia-associated

mortality among MM decedents and evaluated contemporary demographic and place-of-death patterns.

 

Methods

We used CDC WONDER Multiple Cause of Death data. Long-term trends were assessed using 1999–2020

bridged-race data, and contemporary patterns were evaluated using 2018–2024 single-race data. MM was

defined by ICD-10 code C90.0. Core nutritional vulnerability was defined as co-mention of protein-energy

malnutrition or cachexia (E40–E46 and R64). An expanded nutritional-frailty phenotype additionally included

abnormal weight loss and dysphagia (ICD-10: R63.4 and R13). We assessed mortality rates, the proportion of MM

deaths involving this phenotype, place of death, demographic/geographic patterns, and selected co-occurring

conditions.

 

Results

From 1999–2020, 294293 MM-associated deaths were identified. Overall MM age-adjusted mortality decreased

from 4.5051 to 3.8011 per 100000 (-15.6%). In contrast, expanded nutritional-frailty phenotype-associated MM

mortality increased from 0.0552 to 0.0891 per 100000 (+61.4%), and the proportion of MM deaths involving

this phenotype increased from 1.23% to 2.47%. Core malnutrition/cachexia-associated mortality increased from

0.0476 to 0.0657 per 100000 (+38.0%). This increase was primarily driven by malnutrition-associated mortality,

which rose from 0.0274 to 0.0597 per 100000 (+117.9%), whereas cachexia-associated mortality decreased.

In 2018–2024, 3282 of 106937 MM deaths involved the expanded phenotype (3.07%). Phenotype involvement

increased with age, from 2.07% among decedents aged 55–64 years to 3.63% among those aged ≥85 years,

and was highest among nursing home/long-term care deaths (4.83%). The West had the highest proportional

burden (3.90%), while the South had the largest absolute number of phenotype-associated deaths. In exploratory

analyses restricted to MM as the underlying cause, frequent co-occurring conditions included renal failure

(21.4%), anemia (19.8%), dysphagia (17.8%), pneumonia (10.8%), and sepsis (10.3%).

 

Conclusion

Despite declining overall MM mortality, mortality associated with nutritional decline increased substantially.

These findings suggest that malnutrition and related frailty markers remain underrecognized end-of-life burdens

in MM and may identify patients who could benefit from earlier supportive care assessment.

CDC WONDER: Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiological

Research, ICD-10: International Classification of Diseases, 10th Revision, MM: multiple myeloma

 

Keywords

MM, multiple myeloma, nutritional vulnerability, malnutrition, end-of-life care, mortality disparities