National Trends in Pancreatic Cancer-Related Mortality: A Population-Based Analysis of Rural–Urban Disparities and the Distribution of Place of Death

Abstract

Background: Pancreatic Cancer is the sixth deadliest cancer across the world, and its incidence has more than doubled in recent decades. The literature lacks comprehensive evidence on rural-urban and place-of-death mortality trends over the last two decades. This retrospective analysis summarizes the mortality trends for deaths involving 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, using ICD-10 codes C25.0 to C25.4 and C25.7 to C25.9 for adults aged 25+ years from 1999 to 2023. The urbanization data were extracted from 1999 to 2020. Urbanization regions were organized, and age-adjusted mortality rates (AAMRs) were calculated per 100,000 population. Joinpoint software was used for evaluating trends. Results: A total of 1,002,439 deaths from pancreatic cancer occurred from 1999 to 2023, with an overall increase in AAMR from 17.254 in 1999 to 18.446 in 2023 (AAPC: 0.3293%). The death rate in rural areas, 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 was less steep (AAPC: 0.20%). Place of death was analyzed as a cross-period distribution, with the majority of deaths occurring in the decedent’s home (48.3%), followed by medical facilities (25.19%) and nursing homes (11.26%). Conclusion: A consistent rise in pancreatic cancer-related mortality with an increasing trend for rural areas emphasizes the discrepancy and the possible need for targeted interventions.