Rising Mortality in Elderly Men with Prostate Cancer and Hypertensive Comorbidity: A Two-Decade Epidemiological Analysis with Projections to 2035
Abstract
Background & Objective: Prostate cancer and hypertensive disease commonly coexist in elderly men via shared cardiovascular risk and androgen deprivation therapy toxicity, yet CDC WONDER studies rarely examine this comorbidity. We assessed mortality patterns, disparities, and projections in men ≥65 years with both conditions. Methodology: We conducted a retrospective, population-based analysis of CDC WONDER Multiple Cause-of-Death data (1999-2024) using ICD-10 codes (C61) for prostate cancer and hypertensive disease (I10-I15) listed as multiple causes of death. The age-adjusted mortality rate (AAMR) was determined based on the 100,000 persons within the US population. The annual percent change (APC) and average annual percent change (AAPC) estimates were obtained from Joinpoint. Subgroup AAMRs were stratified by race, region (2018-2024), and urbanization (through 2020), and site-of-death proportions were assessed (1999-2024). Data were de-identified, exempting IRB review. Results: National AAMR rose from 13.57 to 19.53/100,000 (2018-2024, +44%), across three segments: APC +14.94% (1999-2003, p<0.001), -0.55% (2003-2017, p=0.20), +6.15% (2017-2024, p<0.001). Black men had the highest AAMR (34.33 vs. White 16.54; APC +18.68%, p<0.001, then plateau, p=0.54); Asian men rose (APC +9.63%, p=0.014) then declined non-significantly (p=0.06). The South had the highest regional AAMR (19.92) and the only sustained significant rise (APC +14.77%, p<0.001; +2.49%, p=0.032); other regions plateaued (p>0.33). State-level AAMR was highest in DC (31.13), Mississippi (30.53), Wyoming (26.07); lowest in Massachusetts (8.09), Connecticut (8.61). Large central metro areas showed the sharpest late acceleration (APC +25.37%, p<0.001); nonmetro areas retained modestly higher baseline rates (14.2-14.5 vs. 13.4). Conclusion: This comorbidity mortality population showed accelerating mortality since 2017, with significant racial, regional, and urbanicity disparities. Limitations include death-certificate coding bias and unvalidated long-horizon projections. Findings generalize to comorbid, not prostate cancer-attributable, mortality, supporting targeted surveillance and future forecast revalidation. Key Words: Hypertension, Elderly, Prostate, Mortality.