Global and regional burden of high BMI-related pancreatic cancer from 1990 to 2021: An analysis of GBD study 2021.

e16431 Background: Obesity and overweight represent a significant concern for public health, with recent statistics showing that approximately two thirds of Americans have a body mass index (BMI) above 25. Estimates suggest that obesity and overweight is associated with a 20% increased risk of pancreatic cancer. With the ongoing global obesity epidemic, we aimed at exploring the evolving trends in global burden of high-BMI related pancreatic cancer and identify locoregional healthcare disparities. Methods: This study utilized data from the Global Burden of Diseases (GBD) database to examine high BMI-related pancreatic cancer metrics, including age-standardized death rates (ASDR), years of life lost (YLL), and disability-adjusted life years (DALYs). Search was limited to patients age > 20 with BMI ≥25 kg/m 2 . Data were stratified by continent, socio-demographic index (SDI), and World Bank income groups to identify variations in the burden of high BMI-related pancreatic cancer and its outcomes across diverse demographic and socioeconomic groups. We applied the Joinpoint Regression Program to determine trends and average annual percentage changes (AAPC) over the study period. Results: The global ASDR due to high BMI related pancreatic cancer showed a steady increasing trend from 1990 to 2021. In 1990, the ASDR was 0.024 (95% UI: 0.157 to -0.054), and it increased to 0.106 (AAPC: 4.80; 95% CI: 4.71-4.89) by 2021. There were significant changes in the ASDR from 1990 to 1994 with an annual percentage change (APC) of 8.74 (95% CI: 8.30 -9.18). The global DALYs rate increased from 0.55 (95% UI: 3.53 to -1.23) in 1990 to 2.54 (AAPC: 5.03; 95% CI: 4.85-5.22) in 2021. In continent-wise analysis, North America exhibited the highest ASDRs, with an AAPC of 2.72 (95% CI: 2.59 to 2.86) from 1990 to 2021. Africa had the lowest ASDRs in continental analysis but experienced the largest increase from 1990 to 2021 (AAPC: 14.37, 95% CI: 13.74 to 14.99). Trends in Europe varied, with an overall AAPC of 2.96 (95% CI: 2.83-3.09). High income countries and high SDI regions had higher ASDRs, compared to low- and middle-income countries and low SDI regions. Conclusions: High BMI-related pancreatic cancer shows a steady global increase in ASDR and DALYs, with disparities noted in terms of economic and sociodemographic factors. North America continues to bear the highest burden, while Africa demonstrates the most rapid increase, highlighting significant regional and socioeconomic disparities. There is an urgent need for public health interventions, particularly in low- and middle-income regions, to address the growing impact of obesity on pancreatic cancer outcomes and reduce healthcare disparities globally.