Disparities in pancreatic cancer burden across states, sex, and risk factors: A GBD 2021 study.

Abstract

669 Background: Pancreatic cancer is among the most lethal gastrointestinal malignancies in the United States. Identifying where and in whom the burden is highest can guide smarter prevention, earlier detection, and more equitable healthcare planning. Geographic and demographic analysis is essential to help reduce disparities in outcomes. Methods: Data were obtained using the Institute for Health Metrics and Evaluation (IHME) Global Burden of Disease (GBD) 2021 Results Tool. Age-standardized death and DALY rates were analyzed by state and sex. Age-stratified crude mortality and DALYs identified high-burden subgroups. Risk attribution was assessed using DALY percentages and temporal risk factor rankings from 1990 to 2021. Descriptive statistics were performed using Microsoft Excel. Results: In 2021, Louisiana and Mississippi consistently ranked among the highest states across incidence, mortality, and DALY rates, while Colorado, Utah, and North Dakota showed the lowest burden. Males demonstrated higher incidence and mortality than females, and rates rose sharply after age 65, peaking in those ≥80 years. State-level variation persisted across three decades, with the South and Midwest showing the greatest burden. Smoking and high body mass index accounted for the largest share of attributable DALYs, with variation across states. DALY rates peaked in men aged 65–69 and women aged ≥80. Prevalence was highest in Hawaii, Louisiana, and Michigan, highlighting a growing survivor population with long-term care needs. Conclusions: Pancreatic cancer burden in the United States shows striking geographic variation, with consistently high rates in southern states such as Louisiana and Mississippi. The greatest burden occurs in older adults, particularly men. These findings underscore the importance of targeted prevention and improved resource allocation to reduce disparities in pancreatic cancer outcomes. Pancreatic cancer burden in the United States, 2021 (age-standardized per 100,000). Metric Highest State (Rate) Lowest State (Rate) Notable Pattern Incidence Louisiana (12.93) North Dakota (8.78) South vs. Midwest contrast Prevalence Hawaii (11.46) Montana (8.83) Coastal variation Mortality Louisiana (12.39) North Dakota (8.08) Mirrors incidence DALY Louisiana (281.6) Colorado (177.4) Southern burden highest Male Incidence Louisiana (14.46) North Dakota (10.04) Higher than female Female Incidence Louisiana (11.53) North Dakota (7.55) Lower overall Age Group Peak M 80+ yrs (6,651 cases) <20 yrs (2.3 cases) Sharp rise >65 yrs Age Group Peak F 80+ yrs (9,332 cases) <20 yrs (2.1 cases) Sharp rise >65 yrs