Trends and disparities in prostate cancer and tobacco use–related mortality among adults aged ≥55 years in the United States, 1999-2024: A CDC WONDER analysis.

Abstract

e17082 Background: Prostate cancer (PC) is one of the leading causes of death among men in the United States and represents a major public health burden. Tobacco use contributes to PC through carcinogen-induced DNA damage, chronic inflammation, and oxidative stress, particularly among men aged ≥55 years bearing the highest mortality burden. Existing literature is only focused on the mortality due to PC but the major contributing factor such as tobacco addiction needs to be addressed; therefore, this study aims to analyze the national mortality trends due to PC and tobacco use. Methods: National mortality trends involving prostate cancer (C61) and tobacco use (F17, T65.2) were examined using data from the Centers for Disease Control and Prevention WONDER database. Age-adjusted mortality rates (AAMR) per 1 million of adults aged ≥55 years, and temporal changes were quantified using Joinpoint regression to evaluate Average Annual Percentage Change (AAPC) and 95% confidence interval (CI). Results: Between 1999 and 2024, 65,035 deaths were attributed to prostate cancer with concurrent tobacco use, with a sustained overall increase in mortality (AAPC: 10.1; 95% CI: 4.8–15.8). Rising trends were observed across racial groups, including Non-Hispanic (NH) Black/African American (AAPC: 11.7; 95% CI: 8.1–15.3) and NH White populations (AAPC: 12.0; 95% CI: 10.0–14.1). Mortality increased across all census regions, with the steepest incline in the Northeast (AAPC: 13.9; 95% CI: 11.1–16.7), followed by the South (AAPC: 12.0; 95% CI: 8.9–15.2), Midwest (AAPC: 11.1; 95% CI: 9.2–13.0), and West (AAPC: 9.3; 95% CI: 7.6–11.0). Urban–rural differences were evident, with mortality increasing in both metropolitan (AAPC: 13.8; 95% CI: 11.3–16.4) and non-metropolitan areas (AAPC: 14.6; 95% CI: 11.6–17.6). Age-specific analysis demonstrated the most profound increase in mortality among older individuals aged 75–85+ years bearing the burden of 42,178 deaths with a persistent increase (AAPC: 12.2; 95% CI: 10.3–14.2) followed by the individuals aged 55–74 years with 22,857 deaths (AAPC: 9.1; 95% CI: 4.2–14.3). Conclusions: Mortality involving PC and tobacco use has increased substantially over the past two decades, with consistently increasing trends across geo-demographic variables. Older adults (75-85+ years) experience both a higher prevalence of tobacco use and an increased risk of PC, contributing to elevated mortality, underscoring the need for effective population-level tobacco control interventions according to the WHO Framework Convention on Tobacco Control. There is also a need to integrate the tobacco addiction management into targeted prevention strategies including tobacco cessation services, age-specific screening initiatives, and advancements in diagnostic and treatment modalities to mitigate the risk of PC associated mortality.