Temporal trends and demographic and geographic disparities in deaths from pancreatic cancer with co-recorded cardiovascular disease in the United States, 1999–2024

Abstract Objective To characterize the mortality burden, temporal trends, and demographic and geographic disparities in deaths with pancreatic cancer (PC) as the underlying cause and cardiovascular disease (CVD) co-recorded on the death certificate in the United States during 1999–2024. Methods Multiple-cause-of-death data were obtained from the CDC WONDER database. We included US residents aged 25 years or older whose underlying cause of death was malignant neoplasm of the pancreas (ICD-10 code C25) and whose death certificates also recorded CVD (I00–I99). Death counts and age-adjusted mortality rates (AAMRs) with 95% confidence intervals (CIs) were calculated; age-specific crude mortality rates were used for age-group analyses. Joinpoint regression estimated annual percent changes (APCs) and average annual percent changes (AAPCs). Analyses covered sex, age, race/ethnicity, region, state, and urbanization. Non-Hispanic racial trends were analysed separately for 1999–2020 and 2018–2024 because race classifications changed. Results Of 1,007,392 deaths with PC as the underlying cause, 226,245 (22.5%) had co-recorded CVD. Annual deaths increased from 6,210 to 14,049 (126.2%), and AAMR rose from 3.52 to 4.77 per 100,000 (AAPC, 1.26%; 95% CI, 0.77%–1.75%). APCs were 0.31% during 1999–2018, 6.89% during 2018–2021, and 1.80% during 2021–2024 (95% CI, 0.03%–3.60%). In 2024, AAMR was higher in males than in females (5.75 vs. 3.97). Non-Hispanic Black individuals had the highest numerical AAMR (6.48), whereas non-Hispanic White individuals had the most deaths. During 2018–2024, AAPCs were 4.36% (95% CI, 3.59%–5.14%) and 4.35% (95% CI, 2.77%–5.95%) among non-Hispanic Black and White individuals, respectively. Adults aged 85 years or older had the highest age-specific rate; those aged 75–84 years had the most deaths. The West had the highest AAMR (5.46); the South had the most deaths and largest numerical AAPC (1.93%). During 1999–2020, AAPC was numerically larger in nonmetropolitan areas; their 2020 AAMR was 4.42 versus 4.10 in metropolitan areas. Conclusions Population AAMR for deaths with underlying PC and co-recorded CVD increased, with faster growth during 2018–2021. Demographic and geographic variation in recorded mortality supports continued surveillance and further research into cardiovascular comorbidity in PC.