Temporal trends and regional disparities in prostate cancer mortality in the United States, 1999-2023: an analysis of the CDC WONDER database.

BACKGROUND

Prostate cancer continues to be a major cause of cancer-related deaths among men in the United States. Despite declining mortality rates in recent decades, variations across race, region, urban-rural status, and age remain insufficiently characterized. Therefore, updated evidence is essential to inform effective prevention and control strategies.

METHODS

Prostate cancer deaths (ICD-10 code C61) among the U.S. men aged ≥ 45 years from 1999 to 2023 were analyzed using the CDC WONDER database. Age-adjusted mortality rate (AAMR) was calculated per 100,000 population and standardized to the 2000 U.S. standard population. Temporal trends were examined using joinpoint regression to estimate annual percent change (APC) and average APC. Subgroup analyses were conducted by region, race, urban-rural status, and age, with additional assessments at the state level.

RESULTS

Over the 25-year study period, 749,932 prostate cancer-related deaths were reported. Mortality initially declined but began to rise after 2013, reaching a peak of 33,860 deaths in 2023, reflecting a 'decline followed by rebound' pattern. Importantly, the increase in absolute deaths primarily reflects the effects of population aging. The AAMR decreased significantly overall (AAPC, -2.20%; P < .05), although the pace of decline slowed after 2013. This is likely influenced by changes in Prostate-Specific Antigen screening practices. Regionally, the South consistently exhibited the highest mortality, while the Northeast achieved the largest reduction and the West the smallest decline. By race, non-Hispanic (NH) Black men experienced the sharpest decrease yet continued to face the highest mortality, nearly twice that of NH White men. Mortality remained elevated in nonmetropolitan compared with metropolitan areas, and men aged 75 years and older continued to face the greatest risk.

CONCLUSIONS

From 1999 to 2023, prostate cancer mortality among U.S. men aged 45 years and older showed a consistent decline. While the AAMR continued to decrease, the rate of decline slowed after 2013, likely due to changes in prostate-specific antigen (PSA) screening practices. In contrast, the observed rise in the absolute number of deaths mainly reflects demographic effects associated with population aging. The greatest burdens were observed among residents of the South, NH Black men, older adults, and rural populations. State-level AAMRs revealed a clear geographic gradient, with consistently higher rates in the South and lower rates in the Northeast. These findings highlight the need for future prevention and control strategies to prioritize high-risk groups through targeted interventions that promote health equity.