Prevalence of obesity/overweight and its relationship with incidence of pancreatic cancer in the US states using BRFSS and CDC WONDER database of 2021.

Abstract

e22573 Background: Pancreatic cancer (PC) is a leading cause of cancer-related deaths, with a higher incidence in the US compared to other countries. Previous studies identified obesity as a risk factor for PC. However, the association between obesity prevalence and PC incidence at the state level remains unexplored, limiting informed public health decision-making. This study investigated the relationship between age-adjusted incidence rate (AAIR) of PC and the prevalence of obesity/overweight among US states including District of Columbia (DC). Methods: Behavioral Risk Factor Surveillance System 2021 data was used to calculate cumulative prevalence of obese/overweight populations (Body Mass Index ≥ 25 kg/m2) in each state. CDC WONDER database was used to calculate AAIR of PC in 2021 for each state, limited to age groups 15-85+ years. States were ranked in descending order of obesity/overweight prevalence, with the state exhibiting the highest prevalence serving as the reference point. AAIR was reported per 100,000 population per state using 2000 US standard population. The AAIR of the state with the highest obesity/overweight prevalence was used as a denominator to calculate the incidence rate ratio (IRR) between the reference state and the remaining US states. IRR values were interpreted as follows: IRR = 1 indicated no difference, IRR < 1 indicated a lower age-adjusted incidence of PC, and IRR > 1 indicated a higher age-adjusted incidence of PC compared to the reference state. We hypothesized that states with lower obesity/overweight prevalence would have lower AAIR of PC compared to the reference state. Results: West Virgina (WV) had the highest prevalence of obese/overweight individuals (73.6%), with Mississippi and Kentucky sharing the second-highest rate (70.2%). Hawaii (60.3%) and DC (55.4%) had the lowest prevalence. AAIR of WV, 17.6 per 100,000, served as the reference rate for calculating the IRR. Two states, Florida and Indiana, were excluded due to missing data. Kentucky and WV had the same AAIR of PC (IRR: 1). 32 states with a lower obesity/overweight prevalence than WV also had a lower PC incidence. Only 14 states and DC had a lower obesity/overweight prevalence than WV but a higher PC incidence. Connecticut had highest AAIR (IRR: 1.13) when compared to WV but ranked 38 th for obesity/overweight prevalence (65.7%) whereas Arizona had the lowest AAIR (IRR: 0.78) when compared to WV and ranked 28 th for obesity prevalence. Conclusions: PC incidence tends to rise with increasing obesity/overweight prevalence in most states. Exceptions to this trend exist, likely due to the complex interplay of factors contributing to PC, including smoking, physical inactivity and hereditary factors. These factors were not assessed given the limited scope of the study. Further research is needed to evaluate the correlation between obesity and PC and possibly inform state-level health programs and recommendations.