Mortality trends and disparities in bone-metastatic prostate cancer in the United States, 1999–2024: A CDC WONDER analysis.

189 Background: In United States, mortality trends for bone-metastatic prostate cancer remain incompletely characterized. This study examines longitudinal trends and demographic and geographic disparities using a multiple cause-of-death approach. Methods: Mortality data for adults ≥25 years were obtained from CDC WONDER (1999–2024). Deaths required prostate cancer (ICD-10: C61) as underlying cause and bone metastasis (C79.5) as a contributing cause. Age-adjusted mortality rates (AAMRs) per 100,000 were stratified by year, age, race/ethnicity, census region, and urbanization. Joinpoint regression estimated APC and AAPC with 95% CIs; p < 0.05 was considered significant. Results: A total of 73,429 deaths were identified (Table 1). Overall AAMR rose from 1.10 (95% CI: 1.05–1.15) in 1999 to 2.12 (2.06–2.17) in 2024 (AAPC: 2.61; 95% CI: 1.66–3.56; p < 0.001). Four trend segments were identified: decline from 1999–2006 (APC: −5.57), modest rise from 2006–2013 (APC: 2.92), sharp increase from 2013–2018 (APC: 12.91), and continued rise from 2018–2024 (APC: 4.02). Adults aged 65–85+ had the highest burden (AAMR 5.09 to 9.79; AAPC: 2.73; p < 0.001). Non-Hispanic (NH) Black individuals had the highest 2024 AAMR (3.09), compared to NH White (2.12) and Hispanic/Latino (1.62); NH Black AAPC was not statistically significant (1.11; p = 0.37), while NH White showed significant increase (AAPC: 3.16; p < 0.001). The West had the largest absolute increase (0.85 to 2.53; AAPC: 4.75; p < 0.001). Non-metropolitan areas had higher 2024 AAMRs than metropolitan areas (1.94 vs. 1.73). Most deaths occurred at home (48.51%); only 10.47% occurred in hospice facilities. Conclusions: Bone-metastatic prostate cancer mortality increased over 25 years, with persistent disparities by age, race/ethnicity, region, and urbanization. These findings may inform targeted public health planning and resource allocation. Bone-metastatic prostate cancer mortality rates (per 100,000) by demographic groups, 1999 and 2024. Variable Deaths AAMR (95% CI), 1999 AAMR (95% CI), 2024 Overall 73,429 1.10 (1.05–1.15) 2.12 (2.06–2.17) NH Black 10,417 2.47 (2.21–2.73) 3.09 (2.89–3.31) NH White 56,125 1.00 (0.95–1.05) 2.12 (2.06–2.18) Hispanic/Latino 5,088 1.23 (0.98–1.48) 1.62 (1.47–1.78) Midwest 16,594 1.16 (1.06–1.26) 2.29 (2.17–2.42) Northeast 9,092 1.04 (0.94–1.14) 1.27 (1.17–1.37) Metropolitan 41,470 1.07 (1.02–1.13) 1.73 (1.68–1.79)* Non-metropolitan 9,987 1.19 (1.08–1.31) 1.94 (1.81–2.07)* NH = Non-Hispanic. AAMRs per 100,000 population, age-adjusted to the 2000 U.S. standard population. *Urbanization data available through 2020 only.