Trends and Characteristics of Cardiovascular Disease Co- Reported with Benign Prostatic Hyperplasia Among U.S. Male Decedents: A CDC WONDER Analysis, 1999–2024

Background Benign prostatic hyperplasia (BPH) is common among older men, yet national patterns of cardiovascular disease (CVD) co-reported with BPH on death certificates have not been fully characterized. Objective This study explored temporal trends and disparities in deaths involving cardiovascular disease co-reported with benign prostatic hyperplasia among U.S. male decedents from 1999 to 2024. Methods We conducted a retrospective, population-based multiple-cause-of-death analysis of male U.S. decedents using CDC WONDER mortality data from 1999 through 2024. Deaths were included when BPH (ICD-10 code N40) and diseases of the circulatory system (ICD-10 codes I00–I99) were both reported on the death certificate. Analyses examined annual death counts and age-adjusted mortality rates (AAMRs) per 100,000 population overall and by age group, race and ethnicity, U.S. Census region, urbanization, state, and place of death. Age groups were 55–64, 65–74, 75–84, and ≥ 85 years. Temporal trends were evaluated using joinpoint regression, with annual percent changes (APCs) and average annual percent changes (AAPCs). Results From 1999 through 2024, 88,076 cardiovascular disease deaths were co-reported with BPH among male U.S. decedents. The annual number of deaths increased from 2,035 in 1999 to 6,221 in 2024, and the overall AAMR increased from 10.05 to 16.41 per 100,000 population. The AAMR increased significantly from 1999 to 2017 (APC, 0.79% per year) and more sharply from 2017 to 2021 (APC, 10.79% per year), followed by a nonsignificant decline from 2021 to 2024 (APC, − 0.79% per year); the overall AAPC was 2.13% per year. In 2024, crude mortality rates increased with age, from 1.03 per 100,000 among individuals aged 55–64 years to 123.38 per 100,000 among those aged ≥ 85 years. AAPCs indicated significant overall increases across all analyzed racial and ethnic groups with the highest AAPC among Hispanic or Latino individuals (3.42% per year), followed by Asian or Pacific Islander (2.32%), Black or African American (2.28%), and White individuals (2.15%). The highest mean regional AAMR was observed in the West (14.24), followed by the Northeast (12.06), Midwest (11.62), and South (9.57). The Midwest had no significant net change over the study period. From 1999 through 2020, the mean AAMR was higher in nonmetropolitan than metropolitan areas (12.85 vs. 10.24). Most deaths occurred in nursing home or long-term care facilities (33.1%), followed by decedents’ homes (28.6%) and inpatient medical facilities (24.3%). Conclusions CVD mortality co-reported with BPH increased substantially among U.S. male decedents from 1999 through 2024, particularly among men ≥ 85 years with marked variation by race and ethnicity, region, urbanization, and place of death. These findings support continued attention to cardiovascular health among older men with BPH and highlight geographic and care-setting differences that may warrant further investigation. Trial registration Not applicable. This study was a retrospective analysis of publicly available, de-identified mortality data from the CDC WONDER database and did not involve a clinical trial.