National trends in bone-metastatic prostate cancer mortality in the United States, 1999-2024: a multiple-cause-of-death analysis with projections to 2040.

Authors

Kanza Atif, Eshal Atif, Vishan Das, Alaa Eldeeb, Kaneez Fatima, Sadia Qazi, Aziz Abdullah

Published in

Frontiers in oncology. Volume 16. Pages 1882666. Epub Jul 20, 2026.

Abstract

Conventional underlying-cause surveillance shows a declining prostate cancer mortality trend in the United States. MCOD analysis, which also includes deaths where bone metastasis was co-documented as a contributing cause, may identify a different trajectory than single-cause coding. Objective: To characterize 25-year trends in prostate cancer mortality with co-documented bone metastasis, quantify divergence from underlying-cause surveillance, and project age-adjusted mortality rates (AAMRs) to 2040 across demographic and geographic subgroups.
We queried CDC WONDER (1999-2024) for deaths with prostate cancer (ICD-10: C61) as the underlying cause and bone metastasis (C79.5) as a contributing cause. Joinpoint regression characterized temporal trends, and ARIMA and exponential smoothing models with RMSE/MAPE-based selection generated stratum-specific projections. Analyses were stratified by age, race/ethnicity, US Census region, and urbanization.
In total, 73,429 deaths met the dual-code definition. The overall AAMR rose 93%, from 1.10 to 2.12 per 100,000 [average annual percent change (AAPC): +2.61%; 95% CI: 1.66-3.56; p < 0.000001]; however, this net increase followed an initial decline from 1999 to 2006 [annual percent change (APC): -5.57%] and reflected an acceleration to +12.91% annually during 2013-2018. Conventional underlying-cause surveillance showed an AAPC of -1.55%. Non-Hispanic Black or African American men had a mean AAMR 64% higher than non-Hispanic White men (1.89 vs. 1.15 per 100,000); in model-based projections, this ratio widened from 1.54 (2025) to 1.78 (2040). In 2024, men aged 65-85+ had a 17-fold higher AAMR than those aged 45-64. The overall AAMR is projected to reach 3.65 (95% CI: 0.88-6.43) by 2040, with wide prediction intervals reflecting substantial uncertainty.
MCOD surveillance identified a sustained 25-year increase in co-documented prostate cancer and bone-metastasis deaths, diverging from the declining underlying-cause-only trend. The post-2013 acceleration predates the COVID-19 pandemic and persisted in sensitivity analyses. Rates were higher among older men, non-Hispanic Black or African American men, and non-metropolitan residents. As death-certificate-based measures, these estimates reflect documented bone metastasis rather than the true incidence of bone-metastatic disease and may be affected by evolving documentation and coding practices. Findings support incorporating MCOD-based metrics into national prostate cancer surveillance and targeted evaluation of care needs in higher-burden subgroups.

PMID:
42548614
Bibliographic data and abstract were imported from PubMed on 04 Aug 2026.

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