Trends in pancreatic cancer mortality in the United States 1999-2020: a CDC database population-based study

Abstract

Introduction: Pancreatic cancer is a significant public health concern and a leading cause of cancer-related deaths worldwide. This study aimed to investigate pancreatic cancer mortality trends and disparities in the United States (US) from 1999 to 2020.

Methods: Data were obtained from the Centers for Disease Control (CDC) Wide-Ranging Online Data for Epidemiologic Research database. Mortality rates were age-adjusted and standardized to the year 2000 US population. Joinpoint regression was used to analyze temporal trends in age-adjusted mortality rates (AAMRs) by sociodemographic and geographic variables.

Results: Between 1999 and 2020, pancreatic cancer led to a total of 810,628 deaths in the US, an average mortality of nearly 39,000 deaths per year. The AAMR slightly increased from 10.6 in 1999 to 11.1 in 2020, with an associated annual percent change (APC) of 0.2. Mortality rates were highest among individuals aged 65 and older. Black individuals experienced the highest overall pancreatic cancer-related AAMR at 13.8. Despite this, Black individuals experienced a decreasing mortality trend over time (APC -0.2) while White individuals experienced an increasing trend in mortality (APC 0.4). Additionally, individuals residing in rural areas experienced steeper rates of mortality increase than those living in urban areas (APC 0.6 for rural vs -0.2 for urban). White individuals in urban and rural populations experienced an increase in mortality, while Black individuals in urban environments experienced a decrease in mortality, and Black individuals in rural environments experienced stable mortality trends.

Conclusions: Mortality from pancreatic cancer continues to increase in the US, with racial and regional disparities identified in minorities and rural-dwelling individuals. These disparate findings highlight the importance of ongoing efforts to understand and address pancreatic cancer treatment and outcomes disparities in the US, and future studies should further investigate the underlying etiologies of these disparities and potential for novel therapies to reduce the mortality.

Keywords: Disparities; Mortality; Pancreatic cancer; Rural populations; Sociodemographic factors; Urban populations.

Fig. 1

Trends in age‐adjusted, pancreatic cancer‐related mortality rates stratified by sex in the United States, 1999–2020. Overall: 1999–2020 APC 0.24* (95% CI 0.2–0.3); Female: 1999–2008 APC 0.43* (95% CI 0.2–0.7), 2008–2020 APC 0.01 (95% CI −0.1 to 0.2); Male: 1999–2020 APC 0.2* (95% CI 0.2–0.3). *Indicates that the annual percentage change (APC) is significantly different from 0 at α = 0.05

Fig. 2

Trends in age‐adjusted, pancreatic cancer‐related mortality rates stratified by race in the United States, 1999–2020. Hispanic: 1999–2020 APC 0.21* (95% CI 0.0–0.4); NH White 1999–2008 APC 0.6* (95% CI 0.3–0.8), 2008–2020 APC 0.3* (95% CI 0.1–0.4); NH Black 1999–2020 APC −0.2* (95% CI to −0.3 to −0.1); NH Asian 1999–2011 APC 0.5* (95% CI 0.0–1.0), 2011–2020 APC −0.6* (95% CI −1.0 to −0.1); NH AI/AN 1999–2020 APC 0.6 (95% CI −0.0 to 1.3). *Indicates that the annual percentage change (APC) is significantly different from 0 at α = 0.05

Fig. 3

Trends in age‐adjusted, pancreatic cancer‐related mortality rates stratified by geographic density in the United States, 1999–2020. Urban: 1999–2011 APC 0.2* (95% CI 0.0–0.4), 2011–2020 APC −0.2 (−0.5 to 0.0); Suburban: 1999–2020 APC 0.2* (95% CI 0.1–0.3); Rural: 1999–2020 APC 0.6* (95% CI 0.5–0.7). *Indicates that the annual percentage change (APC) is significantly different from 0 at α = 0.05

Fig. 4

Trends in age‐adjusted, pancreatic cancer‐related mortality rates stratified by race and geographic density in the United States, 1999–2020. NH White, urban: 1999–2012 APC 0.4* (95% CI 0.2–1.6), 2012–2020 APC −0.1 (95% CI −1.5 to 0.2); NH White, rural: 1999–2020 APC 0.7* (95% CI 0.6–0.9); NH Black, urban: 1999–2020 APC −0.2* (95% CI −0.4 to −0.0); NH Black, rural: 1999–2020 APC 0.2 (95% CI −0.2 to 0.8)

Fig. 5

Trends in age‐adjusted, pancreatic cancer‐related mortality rates stratified by age in the United States, 1999–2020. 25–44 years: 1999–2020 APC −1.4* (95% CI −1.9 to −0.9); 45–64 years: 1999–2020 APC 0.2* (95% CI 0.1–0.3); 65+ years: 1999–2020 APC 0.3* (95% CI 0.2–0.3). *Indicates that the annual percentage change (APC) is significantly different from 0 at α = 0.05

Fig. 6

State‐level, age‐adjusted, pancreatic cancer‐related mortality rates in the United States from 1999 to 2020