Trends in U.S. Mortality With Co‐Listed Pancreatic Cancer and Type 2 Diabetes, 1999–2020

ABSTRACT National‐level data regarding population disparities and Type 2 Diabetes Mellitus (T2DM)‐specific mortality trends, using ICD‐10 E11 and comparing pancreatic cancer deaths with versus without T2DM, remain incompletely characterized. This study aimed to analyze temporal trends and demographic/geographic disparities in United States pancreatic cancer (PC) + T2DM mortality (1999–2020) to identify high‐risk populations and generate hypotheses for future targeted interventions. We analyzed death records with PC and T2DM from Wide‐ranging Online Data for Epidemiologic Research (CDC WONDER), calculating age‐adjusted mortality rates (AAMRs) and annual percent changes (APCs) across demographic and geographic strata. Concurrently, National Health and Nutrition Examination Survey (NHANES) 2007–2016 data were utilized to estimate the weighted prevalences of key behavioral risk factors (smoking, alcohol, high‐saturated‐fat diet). Among 17 744 deaths, the age‐adjusted mortality rate (AAMR) for deaths with co‐listed PC and T2DM increased from 0.16 to 0.53 per 100 000 population between 1999 and 2020, while mortality from PC without T2DM remained relatively stable. Adults aged 75–84 bore the highest absolute burden, whereas 45–54‐year‐olds showed the fastest recent increase. Hispanics had the fastest overall increase, Non‐Hispanic (NH) Whites experienced sharp recent acceleration, and NH Blacks maintained a heavy baseline burden. Geographically, the AAMR in 2020 was higher in nonmetropolitan than metropolitan areas, although the full‐period average annual percent change (AAPC) was higher in metropolitan areas. Among the four United States Census regions, the West had the highest AAMR in 2020 and the highest full‐period AAPC, whereas the South exhibited the fastest recent increase after 2014. Complementary NHANES data show distinct demographic patterns in behavioral risk factors (smoking, alcohol, high‐saturated‐fat diet) at the population level, providing contextual background for the observed mortality disparities. However, these general‐population estimates are not linked to the mortality cohort and serve only as descriptive context. Deaths with both pancreatic cancer and Type 2 diabetes mellitus recorded on death certificates increased substantially in the United States from 1999 to 2020, while mortality from PC without T2DM remained relatively stable. The coexisting burden is characterized by marked demographic and geographic disparities. While behavioral risk factors may contribute to these patterns, ecological comparisons cannot establish causation, and prospective studies are needed to evaluate targeted interventions such as smoking and dietary management, telehealth expansion, and policy‐level efforts to reduce financial barriers.