Mortality trends and disparities in prostate cancer with co-occurring cardiometabolic disorders among U.S. men aged ≥ 55 years, 1999–2024.

5061 Background: Prostate cancer (PCa) survivors are at significant risk for cardiometabolic disorders (CMD) including hypertension, diabetes, and cerebrovascular diseases which often act as competing causes of death. While PCa survival with CMD has improved but trends in deaths remain poorly characterized across demographic and geographic strata. This study evaluates longitudinal trends to identify success in management and remaining inequities in men aged ≥ 55. Methods: We analyzed U.S. mortality data (1999–2024) from the CDC WONDER database for men aged ≥ 55 years with PCa as the underlying cause of death (UCOD) and CMD as the multiple cause of death (MCOD). Age-adjusted mortality rates (AAMR) per 100,000 and joinpoint regression were used to estimate Annual Percent Change (APC) and Average Annual Percent Change (AAPC). Stratified analyses were performed by race, census region, and urbanization. Results: A total of 151,108 deaths were identified (cumulative AAMR: 18.78). Overall mortality demonstrated a significant declining trend (1999–2024; AAPC: -2.48%, p < 0.001). Significant declines were observed across all racial groups. Black or African American men experienced the highest mortality burden but also the most rapid decline (AAPC: -6.01%, p < 0.001), narrowing the gap with White men (AAPC: -4.33%, p < 0.001). While all regions showed improvement, the Southern U.S. demonstrated the slowest rate of decline (AAPC: -4.13%, p < 0.001) compared to the Northeast, which saw the most substantial reduction (AAPC: -5.76%, p < 0.001). Recent trends (2019–2024) showed sharp decreases across regions, including the South (APC: -11.28%, p = 0.002). Declines were consistent across the rural-urban continuum. Micropolitan (non-metropolitan) areas showed a significant overall decline (AAPC: -1.72%, p < 0.001). However, segments of transient increase were noted between 2015–2020 in Medium Metro (APC: +3.77%, p = 0.004) and Large Fringe Metro (APC: +3.55%, p = 0.005) areas before resuming a downward trend. Conclusions: Mortality for prostate cancer with contributing cardiometabolic causes is significantly decreasing among U.S. men aged ≥ 55. The accelerated decline among Black men and in the Northeast reflects improvements in integrated oncological and cardiovascular care. However, the slower decline in the South and transient increases in specific metropolitan areas underscore the necessity for targeted cardio-oncology interventions. Continued focus on equitable access to cardiometabolic risk management is vital to sustaining these positive trends and eliminating geographic and racial disparities in PCa survivorship.