Sociodemographic and geographic disparities in early-onset pancreatic cancer mortality in the United States, 1999–2020.

e16459 Background: Early-onset pancreatic cancer (EOPC), defined as pancreatic cancer occurring before age 50,represents an increasingly recognized clinical entity of public health concern. Germ line and somatic mutations are involved in about 30% of EOPC .Comprehensive national data characterizing long-term mortality trends and disparities across race, sex, age, andgeographical location remain limited. We examined demographic and geographic patterns in EOPCmortality in the United States. Methods: We performed a population-based analysis using the CDC WONDER Multiple Cause of Deathdatabase (1999–2020). Deaths with pancreatic cancer as the underlying cause (ICD-10 C25)among individuals aged 25–49 years were included. Mortality rates per 100,000 were calculatedby race, sex, five-year age group, and U.S. state. Temporal trends were assessed using log-linearregression to estimate annual percent change (APC). State-level analyses used aggregated multi-year data to characterize geographic heterogeneity. Results: EOPC mortality showed substantial heterogeneity across demographic and geographicstrata. Black adults consistently had the highest mortality rates, followed by Asian/PacificIslander and White adults. Across all racial groups, men had higher mortality than women. Overtime, modest declines in mortality were observed among Black men (APC –1.09%/year) andBlack women (–1.04%), with smaller declines among White men (–0.64%) and White women(–0.42%). Despite these trends, absolute mortality rates among Black adults remainedpersistently higher.Age-specific analyses revealed variation within early-onset disease. Mortality was highestamong individuals aged 45–49 years (mean 4.20 per 100,000), with a modest decline over time(APC –0.55%). In contrast, mortality among adults aged 30–34 years, while low in absoluteterms, demonstrated a slight increasing trend (APC +0.54%), whereas rates among those aged35–39 years remained relatively stable.Geographic analyses identified marked state-level variation, with the highest mean multi-yearmortality rates observed in states such as West Virginia and Arkansas, with regional clusteringin Appalachian and Deep South areas. Conclusions: Early-onset pancreatic cancer mortality in the United States exhibits persistent disparities byrace, sex, age, and geography. These findings identify populations and regions withdisproportionate burden and may inform targeted awareness efforts and strategies to improvetimely diagnostic evaluation.