National trends in incidence of pancreatic cancer among adults aged 70 and older across 204 nations: A global burden of disease study (1990–2021).

e16421 Background: Worldwide, the incidence of pancreatic cancer (PC) is increasing. Assessing the burden of PC and its national patterns is critical for evidence-based policymaking, improved resource allocation, and the development of strategies to mitigate risk factors, improve early detection, and deliver faster, more effective treatments. The Global Burden of Disease Study 2021 (GBD-2021) provides valuable insights into the trends and variations in PC incidence across 204 nations. Methods: We examined data from the GBD-2021 to evaluate the incidence rates of PC in individuals aged 70 and above between 1990 and 2021. To analyze trends over this period, we calculated the Estimated Annual Percent Change (EAPC) along with the corresponding 95% confidence intervals (CI). Results: The incidence of PC has risen at a remarkable rate since 1990. In 1990, the United States of America (USA) reported the highest number of diagnosed cases, followed by China and Japan. However, three decades later, in 2021, this pattern shifted dramatically, with China emerging as the leading nation in PC cases, followed by Japan and the USA.Greenland had the highest incidence rates in 1990 (148.90), which was replaced by United Arab Emirates in 2021 (137.21), with Greenland ranking 5th (114.82). Strikingly, Turkmenistan, which had the lowest incidence rates in 1990 (1.02), experienced an unprecedented 16-fold increase by 2021 (16.7). Meanwhile, Mozambique reported the lowest incidence in 2021 (6.96), followed by Sao Tome and Principe (7.66) and Malawi (7.75). The analysis revealed additional significant trends in PC incidence from 1990 to 2021. The most pronounced increase was observed in Turkmenistan (EAPC: 15.26, 95% CI: 10.84, 21.16), followed by the Republic of Cabo Verde (EAPC: 13.60, 95% CI: 8.61, 19.49) and Mongolia (EAPC: 4.79, 95% CI: 3.11, 7.17). Conversely, the most notable decline in PC incidence was observed in the Republic of San Marino (EAPC: -0.32, 95% CI: -0.52, -0.06), followed by Guam (EAPC: -0.26, 95% CI: -0.39, -0.11) and Cuba (EAPC: -0.23, 95% CI: -0.34, -0.11). Conclusions: The global incidence of PC has risen markedly since 1990, with shifting geographic patterns highlighting significant epidemiological transitions. The dramatic rise in Turkmenistan and declines in regions like San Marino underscore the dynamic nature of PC trends. These findings emphasize the urgent need for region-specific strategies to address this growing public health challenge. Regional incidence percent change. Metric Region 1990 2021 EAPC with 95% CI (1990-2021) Highest incidence percent change Turkmenistan 1.02 16.70 15.26 (10.84, 21.16) Republic of Cabo Verde 5.45 79.67 13.60 (8.61, 19.49) Mongolia 8.78 50.85 4.79 (3.11, 7.17) Lowest incidence percent change Republic of San Marino 80.60 54.4 -0.32 (-0.52, -0.06) Guam 28.04 20.66 -0.26 (-0.39, -0.11) Cuba 54.06 41.27 -0.23 (-0.34, -0.11)