Temporal trends and disparities in pancreatic cancer mortality: A nationwide analysis from 1968-2020.

Abstract

e16428 Background: Pancreatic cancer is among the most aggressive malignancies, with poor survival rates and a rising incidence globally. Understanding long-term trends in pancreatic cancer mortality is crucial for assessing its epidemiological burden, identifying disparities, and evaluating advancements in treatment. Methods: This study examined pancreatic cancer deaths in the United States from 1968 to 2020 using the CDC WONDER database. Mortality data were categorized by ICD codes: ICD-8 (1968–1978), ICD-9 (1979–1998), and ICD-10 (1999–2020). Crude and age-adjusted mortality rates (AAMRs) per 100,000 population were calculated. Joinpoint regression analysis evaluated temporal trends in AAMRs, estimating annual percentage changes (APC) and average annual percentage changes (AAPC) with 95% confidence intervals (CIs). Data were stratified by demographics (gender, race) and regions. Results: From 1968 to 2020, there were 1,507,402 deaths attributed to pancreatic cancer in the U.S. The overall AAMR increased slightly from 16.98 in 1968 to 17.09 in 2020 (AAPC: 0.22; 95% CI: 0.19 to 0.25). Temporal analysis showed distinct phases: a sharp decline from 1968 to 1971 (APC: -1.06; 95% CI: -2.20 to -0.06), stability with slight decline from 1971 to 2003 (APC: -0.044; 95% CI: -0.089 to 0.81), a sharp rise from 2003 to 2006 (APC: 1.0104; 95% CI: -0.25 to 1.30), and relative stability with a gentle incline from 2006 to 2018 (APC: 0.1249; 95% CI: -0.13 to 0.30). 49.3% of the deaths occurred in females while 50.7% occurred in males. The male AAMR decreased by 10.4%, from 21.89 in 1968 to 19.61 in 2018 (AAPC: -0.19; 95% CI: -0.22 to -0.16), whereas the female AAMR rose by 13.2%, from 13.17 to 14.91 (AAPC: 0.23; 95% CI: 0.18 to 0.30). Racially, Black or African Americans accounted for 11.6% of the deaths, while 86.2% deaths occurred in Whites. Whites consistently exhibited higher AAMRs, but Black or African Americans experienced a greater increase in AAMR (AAPC: 0.19; 95% CI: 0.13 to 0.26) compared to Whites (AAPC: 0.082; 95% CI: 0.059 to 0.11). Regionally, the Northeast had the highest AAMR at 17.27, while the West recorded the lowest at 16.10. The AAMRs increased over the study period in all regions except the West, where a slight decline was recorded. Conclusions: Our analysis of fifty-three years of mortality data revealed a concerning rise in AAMRs due to pancreatic cancer, with females, Black or African Americans and the Northeastern region facing disproportionately higher AAMRs. These findings highlight the need for targeted interventions to curb these enduring disparities.