Regional trends in pancreatic cancer incidence, mortality, and disability-adjusted life years in Pakistan, 1990-2023.

Abstract

e16414 Background: Pancreatic cancer is a highly fatal malignancy with limited therapeutic options due to late-stage diagnosis. In Pakistan, rising metabolic risk factors and disparities in healthcare access may be contributing to an increasing burden, yet long-term provincial and sex-specific trends in incidence, mortality, and disability-adjusted life years (DALYs) remain poorly described. We assessed temporal and geographic patterns to inform targeted pancreatic cancer control strategies. Methods: Using Global Burden of Disease (GBD) 2023 estimates, we analyzed pancreatic cancer incidence, mortality, and DALYs in Pakistan from 1990-2023. Data were stratified by province and sex and expressed as age-standardized rates per 100,000 population. Joinpoint regression was used to estimate annual percent change (APC) and average annual percent change (AAPC) with 95% confidence intervals (CIs). Results: From 1990 to 2023, pancreatic cancer incidence increased across Pakistan, with marked provincial variation. The largest long-term increases occurred in Gilgit-Baltistan (AAPC: 2.07%; 95% CI: 1.75–2.39), Islamabad Capital Territory (AAPC: 1.70%; 95% CI: 1.46–1.94), and Azad Jammu & Kashmir (AAPC: 1.66%; 95% CI: 1.33–2.00), followed by Punjab (AAPC: 1.51%; 95% CI: 1.28–1.74) and Sindh (AAPC: 1.30%; 95% CI: 0.96–1.64). Increases were driven by recent accelerations, particularly during 2018–2023 in Punjab (APC: 3.23%; 95% CI: 2.12–4.35) and 2017–2023 in Sindh (APC: 3.08%; 95% CI: 2.11–4.06). Islamabad Capital Territory showed sustained long-term growth with rapid increases during 2020–2023. Khyber Pakhtunkhwa experienced modest growth following declines during 1995–2000, while Balochistan showed lower long-term increases with sharp surges during 2020–2023. Mortality and DALYs increased nationally, with the steepest long-term rises observed in Gilgit-Baltistan (mortality AAPC: 1.98%; 95% CI: 1.68–2.29; DALYs AAPC: 2.19%; 95% CI: 1.84–2.53) and Islamabad Capital Territory (mortality AAPC: 1.61%; 95% CI: 1.38–1.85; DALYs AAPC: 1.67%; 95% CI: 1.45–1.90). Punjab also experienced sustained increases, with pronounced late accelerations during 2018–2023 (mortality APC: 3.18%; 95% CI: 2.12–4.24; DALYs APC: 3.21%; 95% CI: 2.00–4.44), while Sindh and Azad Jammu & Kashmir showed early declines during 1990–1996 followed by renewed growth after 2017. Across all provinces, males consistently experienced higher incidence, mortality, and DALY rates than females. Conclusions: Pancreatic cancer burden has increased substantially in Pakistan since 1990, with pronounced provincial and sex-based disparities. Males and residents of Islamabad Capital Territory, Punjab, and Sindh experienced the greatest and most sustained increases. Strengthening early detection, equitable access to care, and cancer surveillance is urgently needed, particularly in high-burden regions.