Two decades of mortality trends in pancreatic cancer and diabetes mellitus: A retrospective cross-sectional study of the United States population (1999–2020)

The incidence of pancreatic cancer (PC) is on the rise, making it a leading cause of cancer deaths, particularly with aging, obesity, and diabetes mellitus (DM). However, trends in mortality among individuals affected by both conditions in the United Stated (US) remain inadequately understood. This study aims to examine national mortality trends from 1999 to 2020 among adults aged ≥45 years with coexisting PC and DM. We investigated death trends related to PC and DM in adults aged 45 years and older between 1999 and 2020 using mortality data from the CDC Wide-Ranging Online Data for Epidemiologic Research (CDC WONDER) system. We calculated age-adjusted mortality rates (AAMRs) and crude mortality rates (CMRs) per 10,00,000 people. The annual percent change (APC) and associated 95% confidence intervals (CIs) were used to assess temporal patterns. We stratified the study by sex, race/ethnicity, year, urban/rural status, and US region to identify demographic and geographic inequalities. We performed a sensitivity analysis restricting deaths to PC as underlying cause with DM contributory, recalculating AAMRs/average annual percent changes using identical Joinpoint settings. From 1999 to 2020, 60,213 deaths were attributed to the combined effects of PC and DM among adults aged ≥45 years. The AAMR was higher in males (28.68 per 10,00,000) than in females (18.91 per 10,00,000). The non-Hispanic (NH) Black population had the highest AAMR (35.50 per 10,00,000), followed by Hispanic or Latino (26.57), NH White (22.09), and NH Asian or Pacific Islander (20.06). The age-specific CMR peaked in individuals ≥85 years (75.01 per 10,00,000). Regionally, the West (25.92) and Midwest (24.71) had the highest mortality, with elevated rates in rural areas (26.13). Nebraska recorded the highest state-level mortality (37.60 per 10,00,000). Sensitivity results confirmed increases overall (average annual percent change: 1.50; 95% CI: 0.98-2.02), steeper in males (1.99) and rural residents (2.33) versus females (0.94) and urban (1.24). From 1999 to 2020, AAMR due to coexisting PC and DM rose significantly across US demographic and geographic groups. These findings highlight the growing dual burden of these conditions and the urgent need for targeted prevention and equitable access to care.