Pancreatic cancer mortality trends attributable to high fasting blood sugar over the period 1990-2019 and projections up to 2040

Abstract

Background: Pancreatic cancer (PC) is a prevalent malignancy within the digestive system, with diabetes recognized as one of its well-established risk factors.

Methods: Data on PC mortality attributed to high fasting blood sugar were retrieved from the Global Burden of Disease (GBD) study 2019 online database. To assess the temporal trends of PC burden attributable to high fasting plasma glucose (HFPG), estimated annual percentage changes (EAPCs) for age-standardized death rates (ASDRs) between 1990 and 2019 were determined using a generalized linear model. Furthermore, a Bayesian age-period-cohort (BAPC) model using the integrated nested Laplacian approximation algorithm was employed to project the disease burden over the next 20 years.

Results: Globally, the crude death number of PC attributable to HFPG almost tripled (from 13,065.7 in 1990 to 48,358.5 in 2019) from 1990 to 2019, and the ASDR increased from 0.36/100,000 to 0.61/100,000 with an EAPC of 2.04 (95% CI 1.91-2.16). The population aged ≥70 years accounted for nearly 60% of total deaths in 2019 and experienced a more significant increase, with the death number increasing approximately fourfold and the ASDR increasing annually by 2.65%. In regions with different sociodemographic indexes (SDIs), the highest disease burden was observed in the high-SDI region, whereas more pronounced increasing trends in ASDR were observed in the low to middle-SDI, low-SDI, and middle-SDI regions. Additionally, a significantly negative association was found between EAPCs and ASDRs of PC attributable to HFPG from 1990 to 2019. Moreover, the BAPC model predicts that ASDR and age-standardized disability-adjusted life-years (DALYs) rate for PC attributed to HFPG was projected to increase obviously for men and women from 2019 to 2040.

Conclusions: The burden of PC attributed to HFPG has increased globally over the past three decades, with the elderly population and high-SDI regions carrying a relatively greater disease burden, but more adverse trends observed in low-SDI areas. Furthermore, the burden is projected to continue increasing over the next 20 years. Hence, more tailored prevention methodologies should be established to mitigate this increasing trend.

Keywords: diabetes; global trend; high fasting plasma glucose; pancreatic cancer; projection.

Figure 1

Trends in ASDR and age-standardized DALYs rate of pancreatic cancer attributed to HFPG among men, women, and both sexes in different SDI regions from 1990 to 2019. ASDR, age-standardized death rate; DALYs, disability-adjusted life-years; HFPG, high fasting plasma glucose; SDI, sociodemographic index.

Figure 2

Distribution of ASDR and age-standardized DALY rate for pancreatic cancer attributed to HFPG by age group in 1990, 2010, and 2019. The horizontal axis represents the ASDR and age-standardized DALYs rate (per 100,000 persons), whereas the vertical axis represents different age groups. The blue stripe on the left represents women, whereas the yellow stripe on the right represents men. ASDR, age-standardized death rate; DALYs, disability-adjusted life-years; HFPG, high fasting plasma glucose.

Figure 3

Global disease burden of pancreatic cancer attributed to HFPG for both sexes across 195 countries and territories. (A) ASDR of pancreatic cancer attributed to HFPG in 2019. (B) EAPC of ASDR for pancreatic cancer attributed to HFPG from 1990 to 2019. HFPG, high fasting plasma glucose; ASDR, age-standardized death rate; EAPC, estimated annual percentage change.

Figure 4

Correlation between EAPC and ASDR of pancreatic cancer attributed to HFPG in 1990. The size of the circle is proportional to the number of pancreatic cancer cases. EAPC, estimated annual percentage change; ASDR, age-standardized death rate; HFPG, high fasting plasma glucose.

Figure 5

(A) Trend in ASDRs of pancreatic cancer attributed to high fasting plasma glucose (HFPG) among/across 21 regions based on SDI in 2019. For each region, points from left to right depict estimates from each year from 1990 to 2017, with expected values shown as the black line. (B) ASDRs of pancreatic cancer attributed to HFPG across 195 countries and territories by SDI in both sexes, 2019. Expected values are shown as the black line. Each point shows observed age-standardized DALY rate for a certain country in 2019. ASDRs, age-standardized death rates; HFPG, high fasting plasma glucose; SDI, sociodemographic index.

Figure 6

Observed and predicted trends of ASDRs and age-standardized DALYs of pancreatic cancer attributed to HFPG by sex globally from 1990 to 2040 using the BAPC model. (A) ASDRs of male. (B) ASDRs of female. (C) Age-standardized DALYs of male. (D) Age-standardized DALYs of female. The shadow in the figure represents uncertainty intervals, suggesting that mortality could fluctuate dramatically as the corresponding rates rise or fall by 1% per year, with each shade corresponding to a change of 1%. ASDRs, age-standardized death rates; DALYs, disability-adjusted life-years; HFPG, high fasting plasma glucose; BAPC, Bayesian age-period-cohort; UIs, uncertainty intervals.