Impact of tobacco use and sociodemographic factors on mortality in pancreatic cancer in the United States: A time trend analysis.

Abstract

e16432 Background: Significant advancements in pancreatic cancer treatment have improved survival, yet mortality remains high due to disease complexity. The impact of therapeutic progress, specialized care access, and supportive measures on mortality over the past two decades is unclear. Additionally, the effects of smoking and sociodemographic factors on pancreatic cancer mortality remain understudied. Methods: We analyzed pancreatic cancer mortality trends linked to tobacco use (2000–2023) using CDC WONDER data. Deaths were categorized by age, race/ethnicity, gender, and rural/urban residency. Age-adjusted mortality rates (AAMR) were standardized to the 2000 US census. Joinpoint regression assessed annual and average percentage changes (APC, AAPC). Results: A total of 47,137 deaths related to Pancreatic cancer and tobacco use were identified (17,716 < 65y and 29,421 ≥65y) between 2000 and 2023. The AAMR increased from 0.06 in 2000 to 1.29 in 2020 and then decreased to 1.22 in 2023 (AAPC 14.7, CI (13.8-16.7), p = 0.001). For patients < 65y, the AAMR increased from 0.04 in 2002 to 0.57 in 2019 and then slightly decreased to 0.50 in 2023 (AAPC 10.79, CI (9.63-12.85) p = 0.001). For patients ≥65y, AAMR increased from 0.24 in 2002 to 4.77 in 2021 and then slightly decreased to 4.60 in 2023 (AAPC 12.15, CI (10.64-15.10) p < 0.001). For male patients, AAMR increased from 0.12 in 2002 to 1.72 in 2020 and then slightly decreased to 1.60 (AAPC 12.42, CI (11.36-14.35) p < 0.001). For female patients, the AAMR increased from 0.04 in 2002 to 0.92 in 2023 (AAPC 12.10 CI (10.46-14.00) p < 0.001). For non-Hispanic whites (NHWs), the AAMR increased from 0.22 in 2003 to 1.46 in 2022 (AAPC 9.62, CI (9.06-10.60) p < 0.001). For non-Hispanic blacks (NHBs), the AAMR increased from 0.31 in 2003 to 1.43 in 2020 and then decreased to 1.29 in 2023 (AAPC 7.04, CI (6.13-8.44) p < 0.001). From 2000 to 2020, as per the 2013 NCHS Urban-Rural Scheme for Counties, AAMR for residents of urban counties increased from 0.05 in 2005 to 1.19 in 2020 (AAPC 13.14 (11.69-15.46), p < 0.001). For residents of rural areas, the AAMR increased from 0.13 in 2002 to 1.83 in 2020 (AAPC 15.41, CI (14.04-17.65) p = 0.001). Conclusions: This analysis reveals a significant rise in age-adjusted mortality rates (AAMR) from pancreatic cancer linked to tobacco use in the U.S. (2000–2023), with a recent slight decline. Mortality increased more sharply in individuals ≥65 years, men, and rural residents, while women showed consistent growth. Non-Hispanic whites had higher overall rates, though non-Hispanic blacks showed a recent decline. Geographic and sociodemographic disparities highlight the need for targeted prevention strategies, including tobacco cessation programs and equitable healthcare interventions.