Rural-urban disparities in pancreatic cancer mortality hotspots in the United States.

Abstract

661 Background: Pancreatic Cancer is the sixth deadliest cancer across the world, and its incidence has more than doubled in recent decades. Literature lacks comprehensive evidence regarding its mortality trends across the last two decades. This retrospective analysis summarizes the death trends for pancreatic cancer patients from 1999 to 2023, with urban and rural stratification to better direct interventional strategies. Methods: Data from death certificates were extracted using the CDC WONDER database's multiple cause of death model, utilizing ICD-10 codes C25.0 to C25.4 and C25.7 to C25.9 for adults aged 25+ years from 1999 to 2023. Data were organized by urbanization regions, and age-adjusted mortality rates (AAMRs) were calculated per 100,000 population. Joinpoint software was used for evaluating the trends. Results: A total of 1,002,439 deaths were attributed to pancreatic cancer from 1999 to 2023, with an overall increase in AAMR from 17.254 in 1999 to 18.446 in 2023 (AAPC: 0.3293%). Death rate in rural areas(overall AAMR: 17.685), though declining initially (APC: -0.2572%), has increased persistently since 2003 (APC:0.773%), surpassing the urban death rate from 2010 onwards. The rise in urban fatality rates(overall AAMR: 17.62) was less steep (APC:0.20). 484,428 deaths occurred in decedents’ homes, followed by 235,927 deaths in inpatient medical facilities and 112,874 deaths across nursing homes. Conclusions: A consistent rise in pancreatic cancer mortality with an increasing trend for rural areas emphasizes the need for better and targeted interventions. Deaths and AAMRs per 100,000 for urbanization & place of death mortality trends related to pancreatic cancer in adults in the U.S. between 1999 and 2023. Variable Deaths (n) AAMR (95% CI) Overall 1,002,439 17.662(17.254-18.446) Urbanization  Urban 698,805 17.62(17.296-18.019)  Rural 148,558 17.685(17.024-18.955) Place of death % Deaths  Inpatient Medical Facility 235,927 23.5%  Outpatient Medical Facility/ER 16,681 1.66%  Decedent's home 484,428 48.3%  Hospice facility 93,638 9.34%  Nursing home/long-term care 112,874 11.3%