Trends in Pancreatic Neuroendocrine Tumor-Related Mortality in the United States, 1999-2023, With Forecasts to 2033

OBJECTIVES: Pancreatic neuroendocrine tumors (pNETs) are uncommon neoplasms, and contemporary US population-level mortality evaluations for malignant endocrine neoplasms of the pancreas are limited. This study assessed long-term mortality trends and forecast future trajectories for malignant neoplasms of the endocrine pancreas using US death-certificate data. METHODS: In this study, CDC WONDER Multiple Cause of Death public-use death-certificate data from the USA were analyzed for 1999 to 2023. Deaths were identified using ICD-10 code C25.4 when listed anywhere on the death certificate. Age-adjusted mortality rates (AAMRs) per 1,000,000 population were standardized to the 2000 US standard population. Joinpoint Regression Program estimated annual percent change (APC) using Monte Carlo permutation testing (2-tailed, P<0.05). ARIMA models generated 10-year forecasts. RESULTS: From 1999 to 2023, 1912 deaths were attributed to pNETs (894 women and 1018 men). Overall, AAMR declined significantly from 2004 to 2019 (APC -12.38; 95% CI: -25.46 to -11.25). Female AAMR decreased significantly from 1999 to 2019 (APC -11.08; 95% CI: -13.30 to -10.09). Male AAMR decreased significantly from 2004 to 2019 (APC -13.27; 95% CI: -19.54 to -11.85) and increased significantly in 2019 to 2023 (APC 18.94; 95% CI: 0.56 to 72.06). The highest deaths occurred in California (181) and Texas (118). Forecasted overall AAMR in 2033 was 0.12 per 1,000,000 (95% prediction interval -0.65 to 0.90; lower bounds truncated at 0). CONCLUSIONS: The United States pNET-related mortality declined significantly from 2004 to 2019, with an upturn after 2019 (significant in males). Forecasts suggest low mortality through 2033, but with substantial uncertainty and limitations in death-certificate coding.