Subnational inequalities and socioeconomic gradients in prostate cancer burden across Mexico, 2000-2023

Prostate cancer is a major cause of cancer-related morbidity and mortality among men worldwide. In Mexico, substantial socioeconomic disparities across states may influence disease detection, access to care, and clinical outcomes. We evaluated national and subnational trends in prostate cancer burden between 2000 and 2023 and examined their relationship with socioeconomic marginalization.

We analyzed estimates from the Global Burden of Disease (GBD) Study 2023 for Mexico and its 32 states. Incident cases, deaths, disability-adjusted life years (DALYs), and age-standardized incidence (ASIR), mortality (ASMR), and DALY rates (ASDR) were obtained for 2000-2023. Temporal trends were assessed using weighted log-linear models, and annual percentage changes (APCs) were calculated. Socioeconomic inequalities were evaluated using the 2020 marginalization index developed by the Mexican National Population Council (CONAPO). Associations between marginalization and prostate cancer burden were assessed using Spearman correlation analyses.

Between 2000 and 2023, incident prostate cancer cases increased from 10,697 to 23,085, deaths from 4,759 to 8,904, and DALYs from 88,581 to 162,325. Despite these increases, age-standardized burden declined, with ASIR decreasing from 40.70 to 37.59 per 100,000 population, ASMR from 19.80 to 15.65, and ASDR from 344.34 to 271.00. Considerable geographic heterogeneity was observed across states. Higher marginalization was not only associated with lower 2023 ASIR (ρ = -0.556, p = 0.001), ASMR (ρ = -0.471, p = 0.007), and ASDR (ρ = -0.485, p = 0.005), but also with slower improvements over time, including less favorable APCs for incidence (ρ = 0.555, p = 0.001), mortality (ρ = 0.514, p = 0.003), and DALYs (ρ = 0.467, p = 0.007).

Although age-standardized mortality and DALY rates declined in Mexico between 2000 and 2023, the absolute burden of prostate cancer increased substantially, a pattern consistent with population aging and demographic growth. Persistent geographic and socioeconomic differences were observed. More marginalized states had lower estimated age-standardized burden in 2023 but less favorable temporal trends. Because diagnostic coverage, cancer registration, stage, treatment, and healthcare utilization were not measured, the lower estimated rates cannot be interpreted as evidence of lower underlying disease risk and may, among other explanations, reflect incomplete detection or surveillance. Strengthening equitable access to early diagnosis, specialized care, and cancer surveillance may help reduce subnational inequalities.