Evaluating disparities in prostate cancer-related mortality among diabetic adults in the United States and Texas: A 21-year observational study (1999-2020).

• DOI: 10.1200/jco.2025.43.5_suppl.30
• Publication Date: 2025-02-18T14:32:56Z
• Authors: Sidra Naz; Hira Naz; Kashif Ali; Muhammad Hanif; Nirmit Patel

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Background: The prostate cancer (PCa) mortality risk with diabetes is poorly understood and understudied. We aim to study the annual trends and sociodemographic factors in prostate cancer-related mortality among diabetic individuals in the United States and its state of Texas from 1999 to 2020 to evaluate public health initiatives and offer insights for improving patient outcomes. Methods: Mortality trends in PCa among diabetic adults aged ≥25 years were analyzed using the CDC WONDER database, identifying through ICD-10 codes C61 “Prostate Malignant neoplasms” and E14 “Diabetes Mellitus”. Crude and age-adjusted mortality rates (AAMRs) per 100,000 people were extracted. Annual percent changes (APCs) in AAMRs, with 95% confidence intervals, were determined using joint point regression analysis across various demographic (sex, race/ethnicity, age) and geographic (state, urban-rural, regional) subgroups. Results: Between 1999 and 2020, 4477954 documented deaths were attributed to PCa associated with diabetes. The overall AAMR for PCa-related mortality in diabetic adults decreased in the US from an adjusted rate (AR) 109.8 in 1999 to (79.1) in 2018 (APC: -1.84%; 95% CI: -2.22% to -1.58%), then it increased to 100.4 in 2020 (APC: 10.4%; 95% CI: 2.97% to 13.4%). In Texas, AAMR for PCa among diabetic adults decreased from AR 125.5 in 1999 to 93.9 in 2018 (APC: -1.71%; 95% CI: -2.25% to -1.26%), after which it increased to 126.6 in 2020 (APC: 14.3%; 95% CI: 4.83% to 18.9%). The AAMR in U.S. men decreased from 166.8 in 1999 to 119.1 in 2018 (APC: -1.96%; 95%CI: -2.34% to -1.68%) and then increased to 147.7 in 2020 (APC: 9.66%; 95% CI: 2.66% to 12.7%). The non-Hispanic (NH) Black or African American (AA) population has the greatest AAMR (191.6), followed by the NH American Indian or Alaska Native (166.2) and the Hispanic or Latino population with AAMR (117.8). The lower-risk population was NH White with AAMR (87.2) and NH Asian or Pacific Islander (59.1). AAMR also varied by region (South: 116.5; Midwest: 101.2; Northeast: 95.5; West: 75.9), and non-metropolitan areas had higher AAMR (small metro: 100.6; micropolitan: 119.9; non-core areas: 124.3) than metropolitan areas (large central metropolitan: 102.2; large fringe areas: 84.8). The states in the upper 90th percentile of AAMRs were Oklahoma, Louisiana, Mississippi, Kentucky, Ohio, West Virginia, Maryland exhibited an approximately two-fold increase in AAMRs, compared to states falling in the lower 10th percentile i.e Nevada, Kansas, Arizona, Florida, MA, Wyoming, and Colorado. Conclusions: Mortality rates from prostate cancer among diabetic adults have risen in the United States and Texas over the past two decades. However, NH Black or AA, NH American Indian or Alaska Native, Hispanic or Latino men are at more risk than NH White and NH Asian or Pacific Islander.