Journal of racial and ethnic health disparities · 2026
Racial and Geographic Disparities in Co-Documented Prostate Cancer and Hypertension Mortality Among U.S. Men, 1999-2024: A Multiple Cause of Death Analysis.
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Atif Kanza, Atif Eshal, Das Vishan, Qazi Sadia, Mazhar Muhammad Atif, Abdullah Aziz
Аннотация
BACKGROUND: Androgen deprivation therapy for prostate cancer is associated with incident hypertension, but this burden is largely invisible to conventional surveillance because hypertension is recorded as a contributing rather than an underlying cause of death. We characterized 25-year trends and disparities in co-documented prostate cancer and hypertension mortality among U.S. males.
METHODS: Deaths in which ICD-10 code C61 and codes I10-I15 co-appeared on the same certificate were extracted from CDC WONDER Multiple Cause of Death data (U.S. males aged ≥ 45 years, 1999-2024). Age-adjusted mortality rates (AAMRs) were stratified by age, race and ethnicity, Census region and urbanization, and Joinpoint regression estimated annual and average annual percent change (APC, AAPC). Four alternative cause definitions and place of death were also examined.
RESULTS: Co-documentation followed four phases: a sharp rise (APC + 31.4%, 1999-2001), a plateau, renewed acceleration (APC + 13.4%, 2018-2021), and a further plateau; the full-period AAPC was + 3.5% (95% CI 1.9 to 5.1). The AAMR rose from 6.76 to 17.78 per 100,000, and rates rose in every age, race and ethnicity, and regional stratum. Non-Hispanic (NH) Black men carried the highest burden in every year (39.79 vs. 16.91 per 100,000 in NH White men in 2024), although the Black-to-White ratio narrowed from 3.9 to 2.4. The South rose fastest (AAPC + 4.5%) and had the highest 2024 rate, having had the lowest in 1999. Mortality with prostate cancer as the underlying cause fell 42% over the same period.
CONCLUSIONS: Co-documented mortality rose across 25 years while prostate cancer mortality itself fell, so the rise cannot be attributed to a growing number of prostate cancer deaths. The burden remained concentrated in NH Black men, the South and non-metropolitan communities. The post-2021 plateau is consistent with documentation change and with reduced access to care, which these data cannot separate. The findings point to implementation of existing monitoring recommendations as the more likely constraint on reducing this disparity.
METHODS: Deaths in which ICD-10 code C61 and codes I10-I15 co-appeared on the same certificate were extracted from CDC WONDER Multiple Cause of Death data (U.S. males aged ≥ 45 years, 1999-2024). Age-adjusted mortality rates (AAMRs) were stratified by age, race and ethnicity, Census region and urbanization, and Joinpoint regression estimated annual and average annual percent change (APC, AAPC). Four alternative cause definitions and place of death were also examined.
RESULTS: Co-documentation followed four phases: a sharp rise (APC + 31.4%, 1999-2001), a plateau, renewed acceleration (APC + 13.4%, 2018-2021), and a further plateau; the full-period AAPC was + 3.5% (95% CI 1.9 to 5.1). The AAMR rose from 6.76 to 17.78 per 100,000, and rates rose in every age, race and ethnicity, and regional stratum. Non-Hispanic (NH) Black men carried the highest burden in every year (39.79 vs. 16.91 per 100,000 in NH White men in 2024), although the Black-to-White ratio narrowed from 3.9 to 2.4. The South rose fastest (AAPC + 4.5%) and had the highest 2024 rate, having had the lowest in 1999. Mortality with prostate cancer as the underlying cause fell 42% over the same period.
CONCLUSIONS: Co-documented mortality rose across 25 years while prostate cancer mortality itself fell, so the rise cannot be attributed to a growing number of prostate cancer deaths. The burden remained concentrated in NH Black men, the South and non-metropolitan communities. The post-2021 plateau is consistent with documentation change and with reduced access to care, which these data cannot separate. The findings point to implementation of existing monitoring recommendations as the more likely constraint on reducing this disparity.