Abstract Body (Do not enter title and authors here): Background:
Aplastic anemia (AA), a rare hematologic disorder characterized by bone marrow failure, predisposes patients to multisystem complications. Cardiac arrhythmias, potentially driven by chronic anemia, iron overload, and immunosuppressive therapies, may significantly worsen prognosis. However, national trends in arrhythmia-related mortality among AA patients remain unexplored.
Research Question:
What are the trends and demographic disparities in cardiac arrhythmia-related mortality among U.S. adults with AA from 1999 to 2023?
Methods:
We analyzed mortality data from the CDC WONDER database (1999–2023) to assess arrhythmia-related deaths among U.S. adults aged ≥25 years with AA. Age-adjusted mortality rates (AAMRs) per 100,000 were calculated. Trends were evaluated using Joinpoint regression to estimate average annual percent change (AAPC) with corresponding 95% confidence intervals (CIs).

Results
Arrhythmia in patients with aplastic anemia led to a total of 182,484 deaths. The overall AAMR increased from 2.2 in 1999 to 4.9 in 2023 (AAPC: 3.13; 95% CI: 2.92–3.35). Men consistently exhibited higher AAMRs than women (3.77 vs. 2.78, respectively). Moreover, males experienced a steeper rise in mortality compared to females (AAPC: 3.34 vs. 2.86). Among racial and ethnic groups, non-Hispanic (NH) Blacks had the highest mortality burden (AAMR: 3.41), followed by NH Whites (AAMR: 3.28). NH Whites also experienced the most pronounced increase in mortality over time (AAPC: 3.47). Regionally, the Midwest had the highest mortality burden (AAMR: 3.41), followed by the South (AAMR: 3.20). The West, however, saw the steepest rise in mortality (AAPC: 3.98). At the state level, Minnesota reported the highest AAMR, while Utah had the lowest. Individuals residing in rural areas experienced a more pronounced increase in mortality compared to those in urban areas (AAPC: 3.97 vs. 2.74). Age-wise, individuals aged 25–64 years exhibited a steeper rise in mortality compared to those aged 65 and older (AAPC: 4.95 vs. 2.96).
Conclusion
Arrhythmia-related mortality in patients with aplastic anemia has more than doubled since 1999, with the highest burden observed in men, NH Blacks, and residents of the Midwest. Mortality rates rose most steeply among younger adults, rural populations, and in the Western U.S., highlighting widening disparities over time.