Abstract
BACKGROUND: Prostate cancer mortality trends and spatial clustering in Kazakhstan over the last two decades require detailed national and regional assessment using time-trend and spatial statistics. METHODS: A nationwide population-based observational study evaluated prostate cancer deaths (ICD-10 C61) among men in Kazakhstan from 2005 to 2024, calculating crude and age-standardized mortality rates, assessing temporal changes using joinpoint regression, and identifying spatial hot spots/cold spots using Getis-Ord Gi* across five predefined periods (2005-2012, 2013-2017, 2018-2019, 2020-2021, 2022-2024). RESULTS: A total of 7,411 deaths were recorded; the overall crude mortality rate (CMR) was 4.44 per 100,000 men and the age-standardized mortality rate (ASMR) was 6.54 per 100,000 men, with deaths concentrated in ages 65-79 (65-69: 19.2%; 70-74: 22.3%; 75-79: 18.9%) and age-specific mortality peaking at 103.04 per 100,000 in ages 80-84. National joinpoint analysis identified a statistically non-significant, essentially stable trend from 2005 to 2019 (annual percent change [APC] 0.7%, p = 0.397), followed by a statistically significant accelerated decline from 2019 to 2024 (APC =-8.4%, p < 0.001), with an overall average annual percent change (AAPC) of -2.8% (p=0.004) for 2005-2024. Regional ASMR varied substantially (3.1 per 100,000 in Kyzylorda to 10.5 per 100,000 in Almaty city), and mean regional ASMR decreased from 6.57 (2005-2012) to 4.30 (2022-2024) with shifting hot spot/cold spot patterns across periods. CONCLUSIONS: Prostate cancer mortality in Kazakhstan declined significantly over 2005-2024, but substantial and evolving geographic disparities persisted, supporting the need for continued surveillance and targeted regional cancer-control actions.