ORIGINAL RESEARCH article
Front. Oncol.
Sec. Cancer Epidemiology and Prevention
Trends and Disparities in Bone Cancer Mortality Among US Adults from 1999 to 2020: A Joinpoint Regression Analysis Based on the CDC WONDER Database
Provisionally accepted
- Tongling People's Hospital, Tongling, China
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Objective:This study aims to describe trends in bone cancer-related mortality from 1999 to 2020 and analyze disparities across various demographic subgroups.Methods:Data were obtained from the CDC WONDER multiple cause of death database (1999–2020). Deaths of individuals aged 25 years or older with primary malignant bone cancer (ICD-10 codes C40–C41) as the underlying cause were included.AAMRs were calculated. Joinpoint regression analysis was employed to evaluate temporal trends and estimate the APC and AAPC.Results:From 1999 to 2020, a total of 25,859 bone cancer deaths were reported among US adults. The overall ASMR increased from 0.528 per 100,000 (95% CI: 0.495–0.562) in 1999 to 0.599 per 100,000 (95% CI: 0.569–0.682) in 2020, with an AAPC of 0.509 (95% CI: 0.196 to 0.931; p = 0.002) over the 22-year period. Joinpoint analysis identified three distinct segments: a non-significant decrease from 1999 to 2014 (APC = –0.218, p = 0.288), a significant increase from 2014 to 2018 (APC = 4.479, p = 0.157), and a non-significant decrease from 2018 to 2020 (APC = –1.779, p = 0.424). Mortality rates were higher in males (0.712 per 100,000) than in females (0.446 per 100,000). Adults aged 85 years and older had the highest mortality rate (3.430 per 100,000). Black or African American individuals experienced a higher mortality rate (0.584 per 100,000) compared to White (0.561 per 100,000) and Hispanic or Latino (0.335 per 100,000) individuals. Geographically, the South had the highest mortality rate (0.614 per 100,000), while the Northeast had the lowest (0.444 per 100,000).Conclusion:Bone cancer mortality among US adults showed an overall increasing trend from 1999 to 2020, with significant disparities by age, sex, race, and geographic region. The triphasic mortality trend may reflect evolving diagnostic technologies, treatment approaches, and healthcare accessibility. These findings provide valuable insights for public health planning and resource allocation aimed at reducing the burden of bone malignancies.
Keywords: Bone Neoplasms, CDC WONDER, Epidemiology, Healthcare Disparities, Joinpoint regression, Mortality, Trends
Received: 03 Oct 2025; Accepted: 16 Feb 2026.
Copyright: © 2026 Wei, Deng, Ma and Zhang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Xiaosi Zhang
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