A cross-sectional study using the Surveillance, Epidemiology, and End Results Program database to estimate the prevalence of Myelodysplastic syndrome (MDS) in the United States

Abstract

Myelodysplastic syndrome (MDS) is a hematologic disorder characterized by ineffective blood cell production leading to cytopenias and a propensity for progression to acute myeloid leukemia (AML). In this study, we aimed to assess the prevalence of MDS in the United States population using data from the Surveillance, Epidemiology, and End Results (SEER) database. Our analysis revealed that the highest prevalence of MDS was observed in the over 85 age group, with an overall prevalence rate of 0.02%. Furthermore, our findings indicated that the White race had the highest prevalence rate compared to other racial groups. However, it should be noted that the SEER database, most likely due to sampling biases, has a potential underestimation of minority populations, but SEER and the US population are statistically similar enough for comparison. These results suggest a need for further research on the underlying factors contributing to the prevalence of MDS in the United States population; factors such as genetic, environmental, comorbidities, and racial disparities should be explored. Early diagnosis and treatment of MDS are crucial for improving outcomes for patients with this condition. 

To the Editor

Myelodysplastic syndrome (MDS), also referred to as preleukemia, is a group of disorders of the bone marrow cells that results in abnormal hematopoiesis [1]. This morphologic dysplasia of hematopoietic cells results in peripheral cytopenias [2]. In this study, we aimed to estimate the prevalence of primary MDS by extracting data from the Surveillance, Epidemiology, and End Results (SEER) Program database corresponding with the following ICD-O-3 histology codes: 997, 998, and 999 and the following histology/behavior codes: 9975/3, 9986/3, 9989/3, 9993/3. SEER is a database supported by the Surveillance Research Program under the National Cancer Institute’s (NCI) Division of Cancer Control and Population Sciences (DCCPS) that provides cancer statistics information among the U.S. population. Its goal is to reduce the cancer burden among U.S. populations. Estimating the prevalence of MDS is important for improving healthcare planning, understanding disease burden, and guiding early intervention strategies [3].

The population estimates in this study were done using the 2017 and 2018 SEER data, and we analyzed 26 years of data ending with January 1st, 2018. At the date of data collection, the SEER database had 43,926,825 participants enrolled (Tab. 1). We estimated an overall count of 5,746.7 affected with MDS. The prevalence was estimated to be highest in the 85+ age group, showing a pattern of increasing with age. The prevalence was also estimated to be highest in White individuals at 0.03%. In Black, American Indian/Alaskan Native, and Asian or Pacific Islander populations, the prevalence was estimated to be 0.02% (Tab. 1). Moreover, it is important to note that the SEER database is composed of 71% White, 12% Black, 2% American-Indian, and 15% Asian-Pacific Islanders [4], which differs slightly from the demographic distribution of the United States, which is 76% White, 14% Black, 1% American-Indian, and 7% Asian [5]. Therefore, our calculation of the prevalence of AML may underestimate the White and Black populations and overestimate the Hispanic and Asian populations. Moreover, there may be a significant number of unaccounted patients due to factors such as their residency status, limited access to healthcare, and census limitations. These limitations may affect the study’s findings because they would not provide an accurate estimate of the perveance of MDS. The results of a chi-squared test of independence indicated that there was no significant difference between the SEER and the US Census populations (X2 (3, N = 304167848) = 3404209.8855, p < 0.00001) (Tab. 2). This implies that the two populations are statistically comparable, allowing for an estimation of the USA population using SEER.

Table 1. The prevalence of myelodysplastic syndrome in the United States, stratified by age and race

Group	Estimated prevalence percent	Estimated prevalence count	Population at prevalence date	Known alive	Lost	Lost estimated alive	Dead prior to prevalence date
White	0.03%	4455.4	31240899	4335	182	120.4	13873
Black	0.02%	499.1	5224726	484	21	15.1	1125
American Indian/Alaska Native	0.02%	47	897021.5	46	1	1	106
Asian or Pacific Islander	0.02%	661.9	6564178.5	628	60	33.9	1643
Unknown		83.3	0	60	30	23.3	40
00 years at prev date	0.00%	1	522150	1	0	0	0
01–04 years at prev date	0.00%	6	2159900.5	6	0	0	0
05–09 years at prev date	0.00%	10.5	2732193.5	7	4	3.5	3
10–14 years at prev date	0.00%	20.6	2786556.5	17	4	3.6	4
15–19 years at prev date	0.00%	30.5	2781405	28	3	2.5	15
20–24 years at prev date	0.00%	25.9	2954646.5	25	1	0.9	15
25–29 years at prev date	0.00%	30.5	3391241	29	2	1.5	18
30–34 years at prev date	0.00%	39.4	3191280.5	36	4	3.4	15
35–39 years at prev date	0.00%	51.8	3049214.5	46	7	5.8	23
40–44 years at prev date	0.00%	57.3	2779268.5	52	6	5.3	26
45–49 years at prev date	0.00%	117.6	2889978.5	111	7	6.6	65
50–54 years at prev date	0.01%	172.1	2837532.5	161	13	11.1	119
55–59 years at prev date	0.01%	272.7	2873440	258	18	14.7	226
60–64 years at prev date	0.01%	422.1	2591284.5	405	19	17.1	417
65–69 years at prev date	0.03%	667.3	2124581	645	30	22.3	695
70–74 years at prev date	0.04%	866	1598623.5	838	38	28	1114
75–79 years at prev date	0.06%	824.1	1077416	803	34	21.1	1633
80–84 years at prev date	0.09%	836	736037	821	31	15	2177
85+ years at prev date	0.13%	1295.3	850075.5	1264	73	31.3	10222

Our data suggests that MDS is equally prevalent across various ethnic groups. It also suggests that its prevalence increases with age. Despite this, there were still some limitations, mentioned earlier, that led to several unaccounted patients. To improve these limitations, we suggest the use of advanced statistical methods, advocating for policy change, and forming a community based research program that allows diverse communities to participate in research studies and improves data collection. Altogether, with its prevalence in all races, we recommend increased awareness and education regarding MDS in minority patients. In addition, we suggest an increase in the development of screening programs and policies that help target the diverse population of MDS patients. We also encourage an increase in focus on barriers to health care access to allow for the diverse population of MDS patients to have equitable healthcare. It would be beneficial to conduct further epidemiological studies that are not limited by billing codes to validate our findings.

Table 2. A Chi-square test of independence was performed using 2018 estimated population data comparing both the Surveillance, Epidemiology, and End Results (SEER) and the United States. The observed population was recorded in each cell, while the expected population was indicated in parentheses. The individual chi statistics are presented in brackets. The overall chi-square statistic was computed as 3404209.8855, and the p-value was found to be less than 0.00001 at a significance level of less than 0.05

	Estimated SEER Population in 2018	Estimated USA Population in 2018	Row Totals
White	31240899 (33049304.38) [98953.07]	197606407 (195798001.62) [16702.57]	228847306
Black	5224726 (6661487.98) [309883.47]	40902223 (39465461.02) [52306.12]	46126949
American-Indian	897022 (478652.71) [365678.20]	2417371 (2835740.29) [61723.87]	3314393
Asian-Pacific Islander	6564179 (3737380.93) [2138071.41]	19315021 (22141819.07) [360891.18]	25879200
Column Totals	43926826	2.6E+8	304167848 (Grand Total)

Conflict of interests

Authors declare no conflict of interests.

Funding

None declared.