Population-level trends and geographic disparities in pancreatic cancer mortality among individuals with psychoactive substance use disorders: A retrospective analysis.

e22591 Background: Pancreatic cancer is a very lethal malignancy with persistently poor outcomes. Individuals with mental and behavioral disorders due to psychoactive substance use represent a vulnerable population that may experience disproportionate cancer mortality. This study examined temporal trends and disparities in pancreatic cancer mortality among adults with psychoactive substance use disorders in the United States from 1999 to 2023. Methods: The Center of Disease Control (CDC) mortality database was used to extract death certificates data encompassing the International Classification of Diseases 10th Revision (ICD-10) codes C25 for pancreatic cancer and F10-F19 for mental and behavioral disorders due to psychoactive substance use from the years 1999-2023. Joinpoint regression was employed to assess the average annual percent change (AAPC) with a 95% confidence interval (CI). A p value of less than 0.05 represented statistically significant trend. Results: From 1990 to 2023, the overall AAMR rates increased from 0.1 in 1999 to 1.32 in 2023 (AAPC: 11.07; 95% CI: 4.76 to 17.75; p< 0.000001). The highest AAMR was shown by Non-Hispanic Whites (NH White) rising from 0.09 in 1999 to 1.53 in 2023 (AAPC: 12.09; 95% CI: 6.98 to 17.45; p< 0.000002) followed by non-Hispanic Blacks (AAPC: 8.91; 95% CI: 4.25 to 13.78; p< 0.00013) and Hispanic or Latinos respectively (AAPC: 1.39; 95% CI: -0.92 to 3.75; p< 0.24) The overall AAMR in rural areas (1.07) was much higher than urban areas (0.81). North Dakota (2.21) and Vermont (1.77) were the states with highest AAMR respectively. The Midwest shared the highest burden of AAMR among all the regions (AAPC: 13.80, 95% CI: 3.73 to 24.85; p< 0.006228). Conclusions: The rising trend of pancreatic cancer in adults with psychoactive substance use in mental disorders in males, Non-Hispanic White individuals, rural areas, North Dakota, and the Mid-west region underscore the need for targeted health policies. While awareness of the importance of mental disorders is growing, further studies are needed on biological and behavioral links between psychological distress and rapid tumor progression.