Disparities in pancreatic cancer incidence and shifting survival trends in the United States (1999–2021).

Abstract

e16432 Background: Pancreatic cancer remains among the most lethal malignancies in the United States, withpersistently high mortality despite incremental therapeutic advances. Evaluating long-term trendsin incidence, mortality, and mortality-to-incidence rate ratios (MIRRs) is essential for assessingpopulation-level survival gains and identifying demographic and geographic disparities. Methods: We analyzed U.S. pancreatic cancer trends from 1999 to 2021 using the CDC WONDERdatabase. Age-adjusted incidence rates (AAIRs) were obtained from the United States CancerStatistics Incidence dataset, standardized to the 2000 U.S. population. Age-adjusted mortalityrates (AAMRs) and MIRRs were extracted from the 1999–2021 Mortality- Incidence Rate Ratiosdataset. Temporal trends were assessed using Joinpoint regression to estimate average annualpercent changes (AAPCs) with 95% confidence intervals (CIs). Results: From 1999 to 2021, 854,937 pancreatic cancer deaths and 977,683 new cases were reported inthe United States. The age-adjusted incidence rate increased from 10.91 to 13.41 per 100,000(AAPC: 0.90%, 95% CI: 0.82 to 0.98), and the age-adjusted mortality rate increased by 5.7%,from 10.60 to 11.24 per 100,000 (AAPC: 0.29%, 95% CI: 0.24 to 0.36). Despite rising absolutenumbers, the MIRR declined from 0.97 to 0.84 (AAPC: –0.62%, 95% CI: –0.72 to –0.57),indicating modest improvement in survival.By sex, incidence remained higher in males, increasing from 12.47 to 15.25 per 100,000 (AAPC:0.86%, 95% CI: 0.80 to 0.95), compared to 9.61 to 11.85 per 100,000 in females (AAPC: 0.90%,95% CI: 0.83 to 1.00). By race, Black individuals had the highest incidence (14.52 to 15.59 per100,000), followed by White (10.61 to 13.20), Asian/Pacific Islander (8.52 to 9.70), andAmerican Indian/Alaska Native populations (7.95 to 9.21). Incidence among Black individualspeaked at 17.06 in 2018. At the state level, the District of Columbia recorded the highest averageage-adjusted incidence rate at 14.78, and Wyoming had the lowest average rate at 10.33. By age,incidence increased sharply with advancing age. The highest rates were seen among individualsaged ≥85 years (average: 95.54; peak: 100.86), followed by 80–84 (avg: 89.40), 75–79 (77.02),and 70–74 (61.00). Incidence remained below 3 per 100,000 among those under 45. Conclusions: Pancreatic cancer incidence and mortality have continued to rise in the United States, withincidence increasing more rapidly than mortality. Although declining MIRRs indicate limitedsurvival gains, pronounced disparities by sex, race, age, and geography persist. These findings highlight the need for targeted prevention strategies, earlier detection efforts, and equitableaccess to emerging therapies.