Background: Hypomethylating agents were approved for use in treatment of MDS after 2004. This study aims to delineate the discrepancies in survival of MDS at population level before and after approval of these agents. Methods: Using Surveillance, Epidemiology and End Results (SEER-17) database, adult patients with primary MDS, diagnosed between 2001 to 2010 were identified. Overall survival analysis was performed using Kaplan-Meier method and compared by log rank. Period of diagnosis for survival was analyzed between 2001-2005 and 2006-2010. Multivariate analysis was performed using Cox Proportional Hazards regression method. Results: 22,051 patients with MDS with a median age of 76 years were included. Median overall survival (OS) for different age groups was as follows: age < 60 – 59 months, age 60 to70 – 36 months, age > 70 – 23 months, p < 0.001). We found that 5 year OS has improved across all age groups diagnosed from 2006-2010 compared to 2001-2005 (age < 60 – 50.3% vs. 16%, age 60-70 – 37.8% vs. 14 %, age > 70 – 23% vs. 3% p<0.01). Females had a better overall survival than males (32 month vs 24 months respectively, p < 0.001). Blacks had a higher overall survival than whites or other races (34 months vs 27 months) (p-not significant). On multivariate analysis age > 60 years ( HR-1.38 95% CI 1.30-1.46, p<0.01) and male sex ( HR-1.17, 95% CI 1.13-1.21, p<0.01) were significantly associated with higher mortality. Diagnosis after the year 2005 was associated with decreased mortality (HR 0.78, 95% CI 0.74-0.82, P<0.001). Conclusions: Overall survival has continued to improve across all age groups with introduction of hypomethylating agents and better supportive care.