Trends in pancreatic cancer mortality in older adults with diabetes mellitus in the United States (1999–2023).

e16402 Background: Pancreatic cancer, the 3rd leading cause of U.S. cancer deaths, has a 5-year survival rate of 2–11.5% and aggressive progression. Diabetes, doubling in prevalence from 1990–2008, raises mortality risk by 75%. Despite advances, gaps persist in understanding evolving mortality patterns. This study examines 1999–2023 pancreatic cancer mortality trends among diabetics aged ≥65, focusing on sociodemographic disparities to guide interventions. Methods: We analyzed CDC WONDER death certificates (1999–2023) for adults aged ≥65 with pancreatic cancer (ICD-10: C25) and diabetes mellitus (DM) (ICD-10: E10–E14). Age-adjusted mortality rates (AAMRs) per 100,000 individuals were calculated, and changes were examined using annual percent change (APC) and average annual percent change (AAPC) via JoinPoint regression. Results: From 1999–2023, 58,270 deaths were due to pancreatic cancer among adults with DM. Overall, the AAMRs rose from 4.3 in 1999 to 6.9 in 2023 with an AAPC of 1.98% (95% CI: 1.74–2.32). After an initial rise in mortality trends from 1999 to 2002 (APC 4.1*, 95% CI = 1.5–9.4), trends stabilized until 2018 (APC 0.5, 95% CI = -0.6–0.7), followed by a significant rise till 2021 (APC 8.2*, 95% CI = 0.8– 9.6), and a steady rise until 2023 (APC 1.7, 95% CI = -1.1– 5.5). AAMRs increased in males and females (AAPC 2.3% [2.1–2.6] and 1.4% [1.1–1.7], respectively) with males having consistently higher AAMRs than females from 1999 (5.1 vs 3.8) to 2023 (8.8 vs 5.3). Non-Hispanic (NH) Whites showed the greatest rise in mortality trends (AAPC 2.2%), followed by NH Asians/Pacific Islanders (1.1%), Hispanics (0.8%), and NH Blacks/African Americans (0.5%).NH American Indians/Alaskan Natives showed a decline in mortality (-3.3%). Geographically, the South had the highest AAPC (2.7%), followed by the Midwest (1.7%), West (1.1%), and Northeast (1.0%). Rural areas had higher AAMRs (5.7) than urban areas (5). States above the 90th percentile included Nebraska, Ohio, California, Oregon, Minnesota, and Mississippi. Conclusions: Pancreatic cancer mortality among older adults with DM increased significantly from 1999 to 2023. Males and NH Whites had the highest increases, with rural areas and the South most impacted; highlighting the need for targeted interventions requiring collaboration between oncologists, endocrinologists, and public health experts. Demographic characteristics of deaths due to pancreatic cancer in diabetic adults aged ≥65 in the USA (1999–2023). Variable Deaths Average Annual Percent Change (95% CI) Overall 58270 1.98 (1.74–2.32) Male 30610 2.3 (2.1–2.6) Female 27660 1.4 (1.1–1.7) NH White 43715 2.16 (1.97–2.37) NH Asian or Pacific Islander 1964 1.06 (0.44–2.17) NH Black or African American 7455 0.48 (-0.12–1.01) NH American Indians or Alaskan Native 246 -3.31 (-8.25–2.08) Hispanics or Latino 4698 0.81 (0.27–1.51)