{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T17:50:16Z","timestamp":1789062616657,"version":"build-2803163510"},"reference-count":44,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T00:00:00Z","timestamp":1784505600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Oncol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Conventional underlying-cause surveillance shows a declining prostate cancer mortality trend in the United States. MCOD analysis, which also includes deaths where bone metastasis was co-documented as a contributing cause, may identify a different trajectory than single-cause coding. Objective: To characterize 25-year trends in prostate cancer mortality with co-documented bone metastasis, quantify divergence from underlying-cause surveillance, and project age-adjusted mortality rates (AAMRs) to 2040 across demographic and geographic subgroups.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We queried CDC WONDER (1999\u20132024) for deaths with prostate cancer (ICD-10: C61) as the underlying cause and bone metastasis (C79.5) as a contributing cause. Joinpoint regression characterized temporal trends, and ARIMA and exponential smoothing models with RMSE\/MAPE-based selection generated stratum-specific projections. Analyses were stratified by age, race\/ethnicity, US Census region, and urbanization.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>In total, 73,429 deaths met the dual-code definition. The overall AAMR rose 93%, from 1.10 to 2.12 per 100,000 [average annual percent change (AAPC): +2.61%; 95% CI: 1.66\u20133.56; p &amp;lt; 0.000001]; however, this net increase followed an initial decline from 1999 to 2006 [annual percent change (APC): \u22125.57%] and reflected an acceleration to +12.91% annually during 2013\u20132018. Conventional underlying-cause surveillance showed an AAPC of \u22121.55%. Non-Hispanic Black or African American men had a mean AAMR 64% higher than non-Hispanic White men (1.89 vs. 1.15 per 100,000); in model-based projections, this ratio widened from 1.54 (2025) to 1.78 (2040). In 2024, men aged 65\u201385+ had a 17-fold higher AAMR than those aged 45\u201364. The overall AAMR is projected to reach 3.65 (95% CI: 0.88\u20136.43) by 2040, with wide prediction intervals reflecting substantial uncertainty.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>MCOD surveillance identified a sustained 25-year increase in co-documented prostate cancer and bone-metastasis deaths, diverging from the declining underlying-cause-only trend. The post-2013 acceleration predates the COVID-19 pandemic and persisted in sensitivity analyses. Rates were higher among older men, non-Hispanic Black or African American men, and non-metropolitan residents. As death-certificate\u2013based measures, these estimates reflect documented bone metastasis rather than the true incidence of bone-metastatic disease and may be affected by evolving documentation and coding practices. Findings support incorporating MCOD-based metrics into national prostate cancer surveillance and targeted evaluation of care needs in higher-burden subgroups.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fonc.2026.1882666","type":"journal-article","created":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T04:20:23Z","timestamp":1784521223000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["National trends in bone-metastatic prostate cancer mortality in the United States, 1999\u20132024: a multiple-cause-of-death analysis with projections to 2040"],"prefix":"10.3389","volume":"16","author":[{"given":"Kanza","family":"Atif","sequence":"first","affiliation":[{"name":"College of Medicine, Alfaisal University","place":["Riyadh, Saudi Arabia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eshal","family":"Atif","sequence":"additional","affiliation":[{"name":"College of Medicine, 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