Comparative trends in pancreatic cancer burden and risk factors in the USA and China (1990–2021): insights from GBD analysis

Pancreatic cancer (PC) remains a lethal malignancy with rising global incidence, yet disparities in risk profiles between high-income and transitioning economies are poorly characterized. This study compared PC burden trends and attributable risk factors in China and the USA (1990–2021), offering evidence for region-specific prevention. we calculated age-standardized incidence/mortality rates (ASIR/ASMR), with all estimates reported as point values and 95% uncertainty intervals (UI). Joinpoint regression identified temporal inflection points, and future burdens (2022–2030) were projected via ARIMA modeling. Decomposition analysis quantified contributions of aging, population growth, and epidemiology. From 1990 to 2021, China’s ASIR increased from 4.54 (95%UI: 3.84–5.29) to 5.64 (95%UI: 4.52–6.84), representing a 24.2% rise (AAPC: 0.72%, 95%CI: 0.50–0.94), while the USA increased from 9.33 (95%UI: 8.77–9.65) to 10.33 (95%UI: 9.53–10.80) (+ 10.7%, AAPC: 0.33%, 95%CI: 0.14–0.52), driven predominantly by aging (55.7% contribution). Smoking accounted for 28.33% (95%UI: 26.03–30.62) of male PC deaths in China, while metabolic risks dominated in the USA, with 36.41% (95%UI: 4.77–63.81) attributed to high fasting plasma glucose. According to ARIMA forecasts, China’s ASIR is projected to increase to 5.95 (95%CI: 5.61–6.30) per 100,000 by 2030, which indicates a reduction in the disparity between China and the USA, where the ASIR is expected to reach 10.62 (95%CI: 10.20–11.04) per 100,000. Divergent risk drivers necessitate tailored policies: tobacco taxation and smoke-free legislation in China; obesity prevention and glycemic control in the USA. Global prioritization of early detection technologies is critical to mitigate projected mortality.