Leukemia was the seventh most prevalent cause of mortality among cancer patients. It was responsible for 3.2% of new cancer cases and 3.9% of cancer deaths. The Mortality-to-Incidence Ratio (MIR) was previously used to investigate health disparities and cancer treatment results. For a study, researchers sought to look at leukemia incidence, mortality, and MIR trends by gender and race during the last 2 decades. They used Cancer Statistics from the Centers for Disease Control and Prevention’s Wide-ranging Online Data for Epidemiologic Research system to conduct a retrospective population-based analysis (CDC WONDER). Investigators chose people who had leukemia as their malignancy. Over 100,000 participants were studied for age-adjusted mortality and incidence rates for race and gender. With age-adjusted rates, MIR mortality, incidence, and trends were analyzed using negative binomial regression. Between 1999 and 2018, 448,893 deaths were documented as linked to leukemia, with males accounting for 56.85% of those deaths. During the same period, 894,726 new cases of leukemia were reported. Males’ age-adjusted mortality rate was higher than females’ (9.3 vs. 5.2, OR: 1.70 [1.48-1.95]). African Americans and Whites had significantly higher age-adjusted mortality rates than Native Americans (3.5, 6.0, 7.2, OR: reference, 1.74, 2.05), but Asians had a non-significantly higher rate (3.8, OR: 1.09 [0.87-1.36]). Males had much greater occurrence rates (17.9, OR: 1.61 [1.58-1.64]). Compared to the White population, Asian and African American races had lower age-adjusted incidence rates (14.4, 7.9, 10.6, OR: reference, 0.60, 0.79), whereas the Native American race had a significantly higher rate (8.2, OR: 1.15 [1.06-1.24]. In both male and female populations (22.82% and 27.62%, respectively) and African American and White cohorts, the mortality-to-incidence ratio has fallen dramatically over time (24.36% and 23.24%, respectively). The mortality-to-incidence rate ratio had decreased dramatically over the previous 20 years, presumably indicating the success of cancer treatment outcomes in the United States. However, not all races experienced a decrease in mortality. To guide the policy change, more effort and research were required.