Keywords
Mortality Trends
Anatomical Site
Cancer Surveillance
Negative Binomial Regression
Death Certificate Coding
How to Cite
Abstract
Background: Sarcomas are heterogeneous malignancies with prognoses that vary markedly by anatomical site. Whether population-level mortality trends differ across anatomical locations remains unclear.
Methods: Sarcoma-related deaths in the United States from 1999 to 2020 were analyzed using the CDC WONDER Underlying Cause of Death database. ICD-10 codes classified deaths into six anatomical categories: bone, retroperitoneal/peritoneal, trunk soft tissue, extremity soft tissue, head and neck, and unspecified. Negative binomial regression models with a population offset estimated site-specific trends, and an interaction model tested heterogeneity across sites. Sensitivity analyses excluded 2020 and recalculated proportions among specified-site deaths only.
Results: Nearly half of the deaths were coded to unspecified sites (49.8%), with no improvement over time. Among specified sites, bone accounted for the largest share (22.6%), followed by retroperitoneal/peritoneal sarcomas (15.1%). Overall mortality increased by 1.32% annually (IRR 1.013, 95% CI 1.012–1.014), with significant increases across all specified sites. Decomposition showed that retroperitoneal/peritoneal (43.5%) and bone (29.7%) sarcomas contributed the largest shares of the overall increase. Trend heterogeneity was significant (p < 0.001), with trunk soft-tissue and head-and-neck sarcomas increasing the fastest. Findings were robust after excluding 2020 and in specified-site–only analyses.
Conclusions: Mortality coded to sarcoma-related ICD-10 underlying-cause categories increased across all anatomically specified sites, with heterogeneous site-specific trends. Retroperitoneal/peritoneal and bone categories contributed most to the absolute increase, while trunk soft tissue and head and neck categories showed the steepest relative increases.
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