S148 Unraveling the Link: 25-Year Trends in Pancreatic Cancer Mortality Among U.S. Adults Aged 55 and Older With Metabolic Syndrome

Introduction: Pancreatic cancer (PC) remains 1 of the deadliest malignancies in the U.S., with rising incidence and mortality rates, particularly among older adults. Metabolic syndrome (MetS)—a cluster of conditions including hypertension, hyperglycemia, dyslipidemia, and central obesity—has emerged as a significant risk factor for both the development and progression of PC. The pro-inflammatory and insulin-resistant state induced by MetS may accelerate tumorigenesis and worsen outcomes. Despite this biological plausibility, national-level mortality trends in patients with comorbid MetS remain poorly characterized. This study aims to evaluate 25-year trends in PC–related mortality among U.S. adults aged ≥55 years with MetS, highlighting demographic disparities and emerging patterns. Methods: Mortality data was obtained from CDC WONDER using ICD-10 codes for PC and MetS. Age-adjusted mortality rates (AAMRs) per 100,000 were calculated using the 2000 U.S. standard population. Joinpoint regression assessed annual percent change and average annual percent change (AAPC). Trends were analyzed by sex, age, race/ethnicity, region, urbanization, and state. Statistical significance was set at P < 0.05. Results: There were 113,379 deaths attributed to comorbid PC and MetS in adults ≥55, with 46% occurring at home. The overall AAMR rose 107% from 4.12 (1999) to 8.51 (2023) (AAPC: 2.9%, 95% CI: 2.7–3.1, P < 0.000001). Men had higher AAMRs than women (6.8 vs 4.9) and a steeper increase (AAPC: 3.2% vs 2.6%). Non-Hispanic (NH) Blacks had the highest AAMR (8.76), while NH Whites had the steepest rise (AAPC: 3.52%, 95% CI: 3.23–3.90). Adults 75+ had nearly 4 times the AAMR of those 55–74 (11.95 vs 3.42), though the younger group had a faster rise (AAPC: 3.1% vs 2.8%).The West had the highest AAMR (6.23), while the South had the steepest increase (AAPC: 4.23%, 95% CI: 3.74–4.88). Rural areas had higher AAMRs than urban (6.02 vs 5.27) and a faster increase (AAPC: 3.1%, 95% CI: 2.7–3.7). Nebraska, Mississippi, Oklahoma, Maryland, and Minnesota ranked in the top 90th percentile of mortality burden. Conclusion: Mortality from PC and MetS in older adults has doubled over 2 decades, with significant disparities by sex, age, race, and geography. The sharper rise in rural, Southern populations, and NH Whites, calls for targeted public health strategies, improved access to care, and earlier risk identification to curb this growing burden.