Trends in cardiovascular disease mortality among pancreatic cancer patients in the US (1999–2023): Uncovering hidden comorbidities and their impact.

Abstract

e16405 Background: Pancreatic cancer, a highly lethal malignancy, unequally impacts middle-aged populations and often coexists with cardiovascular disease (CVD), increasing mortality. Despite treatment advances, limited data exist on CVD-related deaths in pancreatic cancer patients. This study highlights 1999–2023 trends to uncover demographic disparities in the US for improving survival outcomes. Methods: We analyzed CDC WONDER death certificates (1999–2023) for adults aged ≥45 with pancreatic cancer (ICD-10: C25) and cardiovascular disease (ICD-10: I00-I99). Age-adjusted mortality rates (AAMR) per 100,000 were calculated, and JoinPoint regression was used to estimate annual percent change (APC) and average annual percent change (AAPC). Results: From 1999 to 2023, 235,585 deaths attributed to CVD and pancreatic cancer were reported. Overall, the AAMR rose from 7.4 (1999) to 9.6 (2023), with an AAPC of 1.21 (95% CI 1.07–1.35). Mortality remained stable until 2015 [APC 0.07, 95% CI = -0.96–1.45], slightly increased till 2018 [APC 1.56, 95% CI = -0.60–2.26], followed by a steep rise from 2015-2021 [APC 6.70*, 95% CI = 4.68–7.97], and a progressive rise till 2023 [APC 1.78*, 95% CI = 0.07–4.08]. AAMRs rose for both sexes, with males consistently higher than females [AAPC 1.48 (1.31–1.66) vs. 0.96 (0.83–1.08), respectively]. Males’ AAMRs rose from 8.6 (1999) to 11.5 (2023), while females’ rose from 6.5 to 7.9. Among racial groups, NH American Indians/Alaskan Natives showed the steepest rise (AAPC 2.43%), followed by NH Whites (1.54%), Hispanics (0.63%), NH Blacks/African Americans (0.59%), and NH Asians/Pacific Islanders (-0.79%). Regionally, the South had the highest AAPC (1.89%), followed by the Midwest (1.84%), West (1.50%), and Northeast (-0.06%). Urban areas consistently had higher AAMRs than rural areas (7.4 vs. 7.2). States in the 90th percentile for AAMRs included New York, California, Mississippi, and Nebraska. Conclusions: This analysis of CVD-related mortality in pancreatic cancer patients, reveals a significant rise in AAMRs, especially in males, NH American Indians, residents of urban and Southern US. The study emphasizes the integration of cardiovascular care into pancreatic cancer management for high-risk groups, requiring oncologist-cardiologist collaboration. Average annual percentage change in cardiovascular mortality among pancreatic cancer patients aged ≥45 in the U.S. (1999–2023). Variable Deaths Average Annual Percentage Change (95% CI) Overall 235585 1.21 (1.07–1.36) Male 121508 1.48 (1.31–1.66) Female 114077 0.96 (0.83–1.09) NH White 178095 1.54 (1.40–1.69) NH Asian or Pacific Islander 7731 -0.79 (-1.41–0.09) NH Black or African American 30634 0.59 (0.32–0.87) NH American Indian or Alaskan Native 970 2.43 (1.30– 3.84) Hispanics 17474 0.63 (0.31– 0.98)