S14 Sex-Based Differences in the 20-Year Epidemiologic Shift of Acute Pancreatitis in the United States: A Nationwide Population-Based Analysis (1995 to 2024)

Introduction: Despite gallstones and alcohol being the 2 common etiologies of acute pancreatitis (AP), recent data suggests declining trends in gallstone AP while alcoholic AP remains stable. However, nationwide data in the United States on evolving AP epidemiology and sex-based differences in etiology remain limited. This study aimed to analyze temporal trends in the incidence and prevalence of AP in the United States over 20 years. Methods: A population-based analysis was performed using data from TriNetX, an aggregated real-world healthcare database. Incident cases of AP from 1995 to 2024 were identified using ICD-9 and ICD-10 codes, restricted to the first recorded episode. Age-standardized incidence rates (ASIR) and prevalence rates (ASPR) per 100,000 persons were calculated. Stratified analyses by sex and etiology (ICD-10 data limited to 2016 to 2024) were performed. Temporal trends were assessed using Joinpoint regression, with annual percentage changes (APCs) and 95% confidence intervals (95% CI). Results: From 1995 to 2024, 558,264 incident AP cases were identified. Overall, the ASIR and ASPR of AP showed consistent upward trends, with APCs of 4.33% (95% CI 3.66% to 5.00%) and 5.19% (95% CI 4.68% to 5.70%), respectively. Joinpoint regression revealed distinct phases in AP incidence: sharp increase from 1995 to 1997 (APC 18.45%; 95% CI 7.00% to 26.87%), decline through 2005 (APC -2.41%; 95% CI -5.66% to -0.85%), followed by steady increase until 2018 (APC 7.82%; 95% CI 6.72% to 9.24%). Rates plateaued from 2018 to 2021 (APC -4.39%; 95% CI -7.66% to +6.09%), then increased again through 2024 (APC 12.11%; 95% CI 4.41% to 22.64%). Sex-stratified analyses demonstrated significantly higher ASIR and ASPR in men compared to women, despite parallel upward trends in both groups. Gallstone and alcoholic AP remained the most common etiologies. While all etiologies showed rising ASPRs, only alcoholic and drug-induced AP had significantly increased ASIRs (APC 4.27%; 95% CI 1.32% to 7.35% and 5.76%; 95% CI 1.65 to 10.14%, respectively). Gallstone AP was more prevalent in women, while alcoholic AP was more prevalent in men. In women, the incidence of alcohol-related AP surpassed idiopathic AP in 2020, becoming the second most common etiology. Conclusion: This large-scale, population-based study highlights a rising burden of AP in the United States over the past 2 decades. Alcoholic AP remains predominantly a male disease but is increasing among women, while gallstone AP continues to dominate among women.