Trends of pancreatic cancer-related mortality among patients with type 2 diabetes mellitus in the United States, 1999-2020.
Authors: Iqbal Abdul Ghani , Nasir Muhammad Moiz , Mahmood Umar , Farhan Syed Husain , Haris Muhammad , Amir Suhaina , Shahzad Mohsin , Mahmood Asim , Ahmed Jawad , Siddiqi Rabbia , Memon Roha Saeed , Farhan Syed Ali , Waqar Syed Hamza Bin , Hamouda Danae M. 
Published: June 2024

e22523 Background: The relationship between pancreatic cancer (PC) and type 2 diabetes mellitus (T2DM) is complex and bidirectional. While T2DM can be a risk factor for PC, pancreatic cancer can also lead to the onset or exacerbation of T2DM. Especially when these conditions coexist, individuals confront heightened mortality risks due to the compounded effects of both. Thus, our CDC analysis delves into mortality trends among patients affected by both conditions from “1999 to 2020”. By analyzing extensive datasets we scrutinized how factors such as gender, race, region of residence, and level of urbanization intersect with mortality rates. Our trend analysis highlights the need for effective strategies and interventions for individuals facing these complex health challenges simultaneously. Methods: We used the CDC Wonder database to analyze trends in PC-related mortality in patients with T2DM from 1999 to 2020. Age-adjusted mortality rate (AAMR) per 100,000 people with 95% confidence intervals was calculated for the total population, stratified by gender, race, urban/rural status, and census region. We used the Joinpoint regression software to calculate annual percentage change (APC) trend for each stratification. Results: In the US between 1999 and 2020, there were 20,980 deaths from PC in patients with T2DM. The overall AAMR showed a gradual rise from 0.15 per 100,000 in 1999 to 0.27 in 2008 (APC: 6.23), a relatively constant rate of 0.27 till 2013 (APC: -0.79), followed by a more recent sharp rise to 0.48 in 2020 (APC: 8.86). While both genders showed an increase in AAMR, men showed consistently higher AAMR than women in 1999 (AAMR Men: 0.20 vs Women: 0.12) and 2020 (AAMR Men: 0.60 vs Women: 0.37). Moreover, when stratified by race NH Blacks showed higher AAMR than NH Whites in 1999 (AAMR Black: 0.22 vs White: 0.14) and 2020 (AAMR Black: 0.51 vs White:0.48). Rural areas showed consistently higher AAMR than urban areas throughout the study period, from 1999 (AAMR Rural: 0.22 vs Urban: 0.14) till 2020 (AAMR Rural: 0.64 vs Urban:0.44). Finally, the highest mortality rate was observed in Western region (AAMR: 0.39), followed by the Midwestern region (AAMR: 0.36), Southern region (AAMR: 0.26), and Northeastern region (AAMR: 0.20). Conclusions: PC remains one of the leading causes of cancer-related deaths in developed high-income countries and despite the advancements in medicine, the median survival rate remains low. Considering the high risk of PC in patients with T2DM, it is imperative to devise regulations for regular screening to avoid delays in diagnosis and ensuing treatments. Our study underscores the need for larger population-based studies to further understand the primary factors influencing the observed geographical, racial, and gender disparities.