Disease Burden of Early-Onset Pancreatic Cancer in Adults Aged 20–54 Years in Low- and Middle-Income Countries: A GBD 2023 Analysis

BACKGROUND: Pancreatic cancer incidence rises in low- and middle-income countries (LMICs), yet data on early-onset disease (20-54 years) are scarce. METHODS: Using Global Burden of Disease Study 2023 data (1990-2023), we analyzed incidence, mortality, and disability-adjusted life years (DALYs) for early-onset pancreatic cancer in LMIC adults. Trends were assessed via estimated annual percentage change (EAPC), stratified by World Bank income groups. Decomposition analysis quantified epidemiological/demographic drivers. Socioeconomic inequalities were evaluated using socio-demographic index (SDI); projections to 2050 employed autoregressive integrated moving average models. RESULTS: From 1990 to 2023, LMIC early-onset pancreatic cancer cases and deaths increased by 125% and 128%, respectively. Age-standardized incidence (ASIR EAPC: 0.68%) and mortality rates rose. Lower-middle-income countries showed the steepest incidence surge (+ 282%; ASIR EAPC: 1.65%). Young women (20-34 years) in low/lower-middle-income countries bore higher burden, contrasting higher-income regions. Burden correlated positively with national income and exhibited an S-shaped SDI association. Epidemiological changes drove increases in lower-income settings. Socioeconomic inequalities widened; age-standardized rates are projected to rise through 2050. CONCLUSION: Early-onset pancreatic cancer burden is escalating across LMICs, with distinct patterns by income level. Young women in lower-income settings are specifically vulnerable. Targeted prevention and resource allocation are urgently needed.