S179 Regional and Racial Disparities in Pancreatic Cancer Mortality Among Adults With Diabetes: A 23-Year Analysis Using CDC WONDER (1999 to 2022)

Introduction: Diabetes is a significant risk factor for pancreatic cancer, with nearly half of pancreatic cancer patients diagnosed with diabetes. This study aims to estimate the mortality rate of pancreatic cancer (PC) in individuals with type 2 diabetes (T2DM). Methods: Mortality trends for adults aged ≥25 years with T2DM-associated PC were analyzed using CDC WONDER database, identifying deaths through ICD-10 codes C25 “Pancreas Malignant neoplasms” and E11 “T2DM”. Age-adjusted mortality rates per 100,000 were extracted, and annual percent changes with 95% CIs were calculated across demographic (sex, race/ethnicity, age) and geographic (state, urban-rural, regional) subgroups. Results: Between 1999 and 2022, 2807258 documented deaths were attributed to PC among diabetics in the United States. The overall AAMR for T2DM-related PC mortality increased in the United States from an adjusted rate 38.5 in 1999 to 74.4 in 2022 (APC: 2.98%; 95% CI: 2.61% to 3.39%). In Texas, AAMR increased from adjusted rate 38.2 in 1999 to 77.5 in 2022 (APC: 2.89%; 95% CI: 2.35% to 3.47%). Men had consistently higher AAMRs than women (92 vs 60.6). The AAMR in United States men increased from 45.3 in 1999 to 92 in 2022 (APC: 3.15%; 95% CI: 2.79% to 3.57%). The AAMR in United States women increased from 33.7 in 1999 to 60.6 in 2022 (APC: 2.47%; 95% CI: 2.05% to 2.92%). The non-Hispanic (NH) American Indian or Alaska Native population had the greatest AAMR (117.7), followed by the NH Black or African American (89.3) and Hispanic or Latino population (87.6). Lower-risk groups were NH White (71.1) and NH Asian or Pacific Islander (62.4). AAMR also varied by region (West: 99.6; Midwest: 78.2; South: 68.6; Northeast: 51.2). Non-metropolitan areas had higher AAMR (small metro: 82.4; non-core areas: 87.9; micropolitan areas: 87.8) than metropolitan areas (large central metropolitan areas: 75.3; large fringe: 62.1). The states in the upper 90th percentile were Oregon, California, Idaho, Wyoming, Oklahoma exhibited an approx. Two-fold increase in AAMRs, compared to states falling in the lower 10th percentile Illinois, Louisiana, Georgia, South Carolina, New York. Conclusion: Mortality rates from diabetes mellitus type 2-associated pancreas cancer have risen overall in the U.S. over the past 2 decades. NH American Indian or Alaska Native, NH Black or African American, and Hispanic or Latino men remain at high risk, highlighting the need for further investigation into effective prevention and treatment strategies.