S276 Epidemiology and Projected Trends of Stroke Mortality in Pancreatic Cancer: A CDC WONDER Database Study

Introduction: Pancreatic cancer patients face a 2.5 fold higher risk of stroke compared to the general population due to hypercoagulability, tumor related factors, and treatment effects. Understanding mortality trends in this population is critical for improving clinical management and public health strategies. This study examines stroke related deaths among pancreatic cancer patients in the U.S. from 1999 to 2023, analyzing temporal, demographic, and geographic trends, and forecasts future mortality through 2030. Methods: Mortality data were extracted from the CDC WONDER database utilizing multiple causes of mortality dataset with ICD-10 codes for pancreatic cancer (C25.0–C25.9) and stroke (I60–I69). Age adjusted mortality rates were calculated per million population. Joinpoint regression identified temporal trends, estimating annual percentage changes (APC) in mortality. Stratified analyses were conducted by sex, race/ethnicity, census region, state, and urbanization status. An ARIMA (4,0,0) model forecasted mortality trends through 2030. Results: From 1999 to 2023, 16,547 stroke related deaths occurred among pancreatic cancer patients. Mortality initially declined (1999 to 2015; APC = 0.999%, P = 0.0012) but surged sharply thereafter (2015 to 2023; APC = +8.116%, P < 0.0001), reaching 22.0 deaths/million in 2023. Sex stratified analyses revealed similar trends, with men experiencing higher mortality (25.7 vs 19.2 deaths/million in 2023). Geographically, the Midwest had the highest 2023 age adjusted mortality rates (24.6 deaths/million), while the West showed the steepest increase (APC = +9.25%, P < 0.0001). Racial disparities were evident: Black individuals had the highest peak mortality (34.5 deaths/million in 2023), while Hispanic populations saw delayed but significant increases (APC = +7.71%, P = 0.002). Urban rural differences emerged, with non-metro areas experiencing sharper rises post 2014. Forecasts predict a gradual decline post 2023, reaching 15.16 deaths/million by 2030. Conclusion: Stroke related mortality in pancreatic cancer patients has risen alarmingly since 2015, with disparities across sex, race, and region. The COVID 19 pandemic exacerbated these trends. While forecasts suggest a potential decline, sustained public health interventions particularly in high-risk populations are urgently needed to mitigate this burden. Further research should explore underlying mechanisms, including thromboembolic risks and healthcare access disparities.