Trends in prostate cancer mortality in the United States of America, by state and race, from 1999 to 2019: Estimates from the Centers for Disease Control WONDER database.

Abstract

30 Background: In the United States of America (USA), prostate cancer is the most common cancer in men, and it remained the second leading cause of cancer related mortality. It has a disproportionate burden of disease among minorities. In particular, African American (AA) men have a higher incidence and more aggressive disease course. Our study compares trends in prostate cancer mortality in the United States of America (USA) by race and state from 1999 to 2019. Methods: We used the Center for Disease Control (CDC) WONDER database using ICD-10 code C61 to extract mortality data for malignant prostate cancer. Age standardized death rates (ASDRs) are reported per 100,000 population using the USA standard population. ASDRs were divided into American Indian or Alaskan Native, Asian, Black or African American and, Whites and reported by year for each state. Due to the lack of available data in many states, state-wise analyses were done for white and African American men only. We used Joinpoint regression analysis for trends comparison. Results: Between 1999 and 2019, data was analyzed from 50 states of the USA, of which four started collecting data from 2000, one from 2001, one from 2008, and one from 2009. Three states had data until 2018 only. Data was missing for African American men in 17 states. In 2019, ASDR in African American (13.4/100,000) was significantly higher than Whites (7.3/100,000) (p<0.001). The highest ASDR for African American was observed in Nebraska (33.5/100,000), followed by Wisconsin (17.7/100,000). In contrast, the highest ASDR for whites was observed in Alaska (11/100,000), followed by Utah (10.5/100,000) ASDR decreased by 31.8% in White men at the national level, compared to a decline of 44.6% in African American men. ASDR decreased in all states for both races. For White men, the widest drops were in South Dakota (-45.9%) and Kentucky (-47.0%), and the lowest declines in New Hampshire (-11.5%) and Alaska (-16.0%). For African American men, the largest decreases were in Delaware (-57.8%) and Nevada (-55.3%), and the smallest declines were in Kentucky (-14.9%) and Wisconsin (-20.3%). Conclusions: During the last 20 years, the mortality rate from prostate cancer has consistently dropped in all the states of the USA and for all races. Even though a higher decrease in ASDR was observed in the African American and Asian racial groups, ASDR is still higher in African Americans as compared to Whites.[Table: see text]