Long-term mortality trends from pancreatic cancer and associated second malignancies in the U.S., 1999 to 2023: A CDC WONDER analysis.

e16369 Background: Pancreatic CA and secondary malignancies are major contributors to U.S. mortality. Methods: CDC WONDER data for U.S. adults (≥65 years) from 1999-2023 were analyzed. Age-adjusted mortality rates (AAMRs) per 100,000 were calculated according to population size, year, location of death, age, race, level of urbanization, state, and census region from 1999-2023. Joinpoint regression was used to estimate the average annual percentage change (AAPC) with 95% confidence intervals to assess statistical significance. The ICD-10 codes for pancreatic cancer were C25 and C77, C78, and C79.0–C79.8 for secondary malignancies. Results: Pancreatic CA and secondary malignancies caused 69,411 deaths. AAMRs ranged from 4.97 in 1999 to 11.3 in 2023 per 100,000, and the AAPC was 3.45%. From 1999-2008, AAMR showed a significant decline (APC: -3.09 (95% CI: -3.78 to -2.38)), followed by a significant rise up to 2013 (APC: 4.92 (95% CI: 2.46 to 7.44)) until 2016 (APC: 13.54 (95% CI: 6.41 to 21.15)) and continued to rise until 2023 (APC: 7.04 (95% CI: 6.39 to 7.69]). Males (AAMR: 7.79; 35,211 deaths) had an elevated AAMR per 100,000 and higher mortality than females (AAMR: 5.85; 34,200 deaths). From 1999-2008, males and females exhibited a decline in AAMR, with associated APCs of -3.17 and -3.31, respectively, followed by a sharp increase till 2013-2014, till 2016-2017, and continued to rise until 2023. NH Black (7.21) and NH White (6.21) showed the highest AAMRs, followed by Hispanic (5.26), and NH Asians (4.14) showed the lowest. The number of NH Asians experienced a sharp rise after 2012 (APC: 8.78). NH Black showed a decline from 1999-2008 (APC: -5.03), followed by a rise from 2008-2023 (APC: 6.43). NH Whites mirrored the overall trend, with an AAPC of 3.71%. Hispanics showed an early decline, followed by a significant increase, with an overall AAPC of 2.44%. A consistent upward trend in the crude mortality rate per 100,000 for all age groups was observed. Registered deaths were highest in the 75–84 years age group, followed by 85+ years and 65–74 years. The AAMR declined from 1999-2008 in metropolitan areas (APC: -2.99) and from to 1999-2009 in non-metropolitan areas (APC: -3.35) and increased through 2020, with AAMR 9.43 for nonmetropolitan areas and 9.20 for metropolitan areas. The Midwest (12.21) and West (12.18) showed the highest AAMRs in 2023, followed by the South (11.85). Northeast displayed the lowest AAMR (8.27) and AAPC (1.74%) with a later period of increase in 2009. The western region experienced the most rapid increase over the entire period (AAPC: 4.50%). California, Texas, and Florida showed the largest number of cumulative death counts from 1999-2023. Conclusions: Mortality from pancreatic CA and secondary malignancies has risen substantially among older adults, with persistent sex, racial, and geographic disparities, indicating the need for health equity-focused interventions.