Trends and disparities in prostate cancer mortality among men with hypertension in the United States: A CDC WONDER analysis (1999–2020).

Abstract

e17064 Background: Prostate cancer is a major cause of cancer-related mortality among older men in the United States. Hypertension is highly prevalent in this population and has been associated with adverse oncologic outcomes. However, national trends and disparities in mortality among patients with prostate cancer and hypertension remain poorly characterized. Methods: Mortality data from the CDC Wide-ranging Online Data for Epidemiologic Research (CDC WONDER) database were analyzed for adults aged ≥55 years from 1999–2020. Deaths listing prostate cancer (ICD-10: C61) and hypertensive diseases (ICD-10: I10–I15) as underlying or contributing causes were included. Crude and age-adjusted mortality rates (AAMRs) per 100,000 persons were standardized to the 2000 U.S. population, and temporal trends were assessed using Joinpoint regression to estimate annual (APC) and average annual percent changes (AAPC), stratified by age, race/ethnicity and states. Results: From 1999–2020, 124,668 deaths occurred among individuals with prostate carcinoma and hypertensive diseases, with overall age-adjusted mortality rates (AAMRs) increasing from 4.0 to 11.0 per 100,000 (AAPC 3.77%, 95% CI 2.08–5.48; p = 0.000009). Age-stratified analysis demonstrated the highest mortality among adults aged ≥85 years, with crude mortality rates rising from 18.1 to 58.7 (AAPC 4.95%, 95% CI 3.93–5.97; p < 0.001), while the lowest mortality was observed in the 55–64-year age group (from 0.7 to 1.2; AAPC 3.72%, 95% CI 1.29–6.21; p = 0.0025). Sex-wise, mortality occurred exclusively among males, with AAMRs increasing from 11.0 to 26.8; males experienced a sharp increase from 1999–2001 (APC 32.47%, 95% CI 14.10–53.80; p = 0.001), followed by a non-significant decline from 2001–2018 (APC −0.39%, 95% CI −0.80–0.03; p = 0.069), and a renewed rise from 2018–2020 (APC 15.08%, 95% CI 3.20–28.32; p = 0.015). Race-stratified analysis showed the highest AAMRs among Non-Hispanic (NH) Black or African American individuals (overall AAMR 18.6), followed by NH White (7.1), Hispanic or Latino (6.4), NH American Indian or Alaska Native (5.9), and NH Asian or Pacific Islander populations (4.3). States with age-adjusted mortality rates above the 90th percentile included District of Columbia (17.1), Mississippi (16.4), North Dakota (12.0), Oklahoma (12.0), and Minnesota (11.3). Conclusions: Overall, mortality involving prostate cancer with concurrent hypertension increased significantly from 1999 to 2020 in the United States. Mortality burden was disproportionately higher among NH Black or African American individuals, older age groups and varied substantially across states, indicating persistent demographic and geographic heterogeneity over the study period. These patterns highlight population groups and regions that may benefit from targeted public health planning and resource allocation.