National Trends and Disparities in Mortality From Early-Onset Pancreatic Cancer in the United States, 1999 to 2020

The incidence of early-onset pancreatic cancer (EOPC) is rising among younger adults in the United States, yet it remains unclear whether this trend has affected population-level mortality. We evaluated national trends in EOPC-related mortality and examined disparities by sex, race, ethnicity, and urban-rural residence.

Using the CDC WONDER database, we identified pancreatic cancer-related deaths among adults aged 25 to 44 years from 1999 to 2020. Age-adjusted mortality rates (AAMRs) were calculated using the 2000 US standard population, and temporal trends were assessed using Joinpoint regression (AAPC and APC).

Among 12,166 EOPC-related deaths, overall mortality declined significantly (AAPC: -1.4%; 95% CI: -2.01 to -0.81). Men had higher mortality than women (AAMR 0.9 vs. 0.5 per 100,000), though women experienced a steeper decline. Non-Hispanic Black individuals carried the highest mortality burden (AAMR 1.0 per 100,000) and showed no significant improvement over the study period (AAPC: -0.66%; P=0.2), with a nonsignificant upward trend after 2013 (APC +1.94%) in contrast to significant declines among non-Hispanic White individuals. Urban populations showed significant mortality reductions, and rural trends remained stable.

EOPC mortality declined significantly over 2 decades, likely reflecting broader uptake of multimodal therapy among younger patients, but improvements were not evenly distributed, with persistent disparities among non-Hispanic Black individuals, males, and rural populations. These findings highlight ongoing inequities in pancreatic cancer outcomes and the need for targeted public health and research efforts to address disparities in early-onset disease.