S71 Burden of Cardiovascular Mortality in Older Adults With Pancreatic Cancer: A 25-Year United States Retrospective Study With Sensitivity Analysis

Introduction: Pancreatic cancer (PC) carries a high mortality rate, often compounded by co-morbid conditions such as cardiovascular disease (CVD), which may further worsen patient outcomes. Older adults with PC are particularly vulnerable due to shared risk factors like inflammation, metabolic dysfunction, and treatment-related cardio-toxicity. Despite this, the specific impact of different CVD subtypes on mortality in this population remains poorly defined. This study aims to analyze long-term trends in CVD-related mortality among older adults with PC in the United States and identify which CV conditions contribute most significantly to mortality risk. Methods: Mortality data from CDC WONDER (1999 to 2023) were analyzed using joinpoint regression to assess deaths related to PC and CVD in United States adults aged 65+. Age-adjusted mortality rates (AAMRs) and average annual percent change (AAPC) with 95% CI were calculated. Furthermore, sensitivity analysis was performed to identify which CVD contributes most to the burden in patients with PC. Results: A total of 187,120 deaths were attributed to the combined burden of CVD and PC. From 1999 to 2023, the overall AAMR increased from 16.49 to 21.18 (AAPC: 1.11; 95% CI: 0.95–1.25). Men consistently exhibited higher mortality than women (AAMR: 20.08 vs 14.90) and experienced a steeper increase over time (AAPC: 1.43 vs 0.77). Non-Hispanic (NH) Black individuals faced the highest mortality burden (AAMR: 23.12), while NH Whites showed the most significant rise (AAPC: 1.34). Among U.S. Census regions, the Northeast reported the highest mortality (AAMR: 20.82), but the South demonstrated the fastest rise (AAPC: 1.71). State-level variation was notable, with Nebraska reporting the highest AAMR (29.21) and Utah the lowest (11.09). Urban areas had a slightly higher AAMR than rural areas (16.74 vs 15.87), though rural populations experienced a more rapid rise in mortality (AAPC: 1.21 vs 0.62). Sensitivity analysis revealed that the comorbidity of PC with hypertensive diseases had the steepest increase in mortality (AAPC: 5.16), followed by pulmonary heart disease (AAPC: 5.09) and arrhythmias (AAPC: 4.67). Conclusion: PC patients with coexisting CVD face a rising mortality burden, with disproportionate increases observed in men, NH Blacks, and rural populations. The steepest mortality surges occurred in cases involving hypertensive disease, pulmonary heart disease, and arrhythmias—highlighting critical targets for CV risk stratification and intervention in this high-risk cohort.