National Trends in Pancreatic Cancer-Related Mortality: A Population-Based Analysis of Rural–Urban Disparities and the Distribution of Place of Death
Downloads
DOI:
https://doi.org/10.71079/ASIDE.Onc.082326663Abstract
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.
Keywords:
Pancreatic cancer, Mortality trends, Rural–urban disparities, Place of death, Cancer epidemiology, United StatesReferences
1. Siegel RL, Miller KD, Wagle NS, Jemal A. Cancer statistics, 2023. CA Cancer J Clin. 2023;73(1):17–48. PMID: 36633525. https://doi.org/10.3322/caac.21763 DOI: https://doi.org/10.3322/caac.21763
2. Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, et al. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J Clin. 2021;71(3):209–49. PMID: 33538338. https://doi.org/10.3322/caac.21660 DOI: https://doi.org/10.3322/caac.21660
3. Huang J, Lok V, Ngai CH, Zhang L, Yuan J, Lao XQ, et al. Worldwide Burden of, Risk Factors for, and Trends in Pancreatic Cancer. Gastroenterology. 2021;160(3):744–54. PMID: 33058868. https://doi.org/10.1053/j.gastro.2020.10.007 DOI: https://doi.org/10.1053/j.gastro.2020.10.007
4. National Cancer Institute. Cancer Stat Facts: Pancreatic Cancer. 2025.
5. Didier AJ, Nandwani S, Fahoury AM, Craig DJ, Watkins D, Campbell A, et al. Trends in pancreatic cancer mortality in the United States, 1999–2020: a CDC database population-based study. Cancer Causes Control. 2024;35(12):1509–16. PMID: 39158669; PMCID: PMC11564214. https://doi.org/10.1007/s10552-024-01906-z DOI: https://doi.org/10.1007/s10552-024-01906-z
6. Cheema AAA, Shaikh A, Kumari N, Rafay MA, Khan A. Two decades of mortality trends in pancreatic cancer and diabetes mellitus: A retrospective cross-sectional study of the United States population (1999–2020). Medicine (Baltimore). 2025;104(49):e46372. PMID: 41366957; PMCID: PMC12689041. https://doi.org/10.1097/MD.0000000000046372 DOI: https://doi.org/10.1097/MD.0000000000046372
7. Henley SJ, Anderson RN, Thomas CC, Massetti GM, Peaker B, Richardson LC. Invasive Cancer Incidence, 2004–2013, and Deaths, 2006–2015, in Nonmetropolitan and Metropolitan Counties—United States. MMWR Surveill Summ. 2017;66(14):1–13. PMID: 28683054; PMCID: PMC5879727. https://doi.org/10.15585/mmwr.ss6614a1 DOI: https://doi.org/10.15585/mmwr.ss6614a1
8. Curtin SC, Spencer MR. Trends in Death Rates in Urban and Rural Areas: United States, 1999–2019. NCHS Data Brief. 2021;(417):1–8. PMID: 34582331. https://doi.org/10.15620/cdc:109049 DOI: https://doi.org/10.15620/cdc:109049
9. Ibrahim AA, Tablawy M, Faisal MR, Fdle AS, Ehab S, Ahmed M, et al. Examining the link between tobacco use and gastric cancer mortality: A US population-based perspective (2003–2023). Medicine (Baltimore). 2026;105(19):e48559. PMID: 42116287; PMCID: PMC13166845. https://doi.org/10.1097/MD.0000000000048559 DOI: https://doi.org/10.1097/MD.0000000000048559
10. von Elm E, Altman DG, Egger M, Pocock SJ, Gotzsche PC, Vandenbroucke JP, et al. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. J Clin Epidemiol. 2008;61(4):344–9. PMID: 18313558. https://doi.org/10.1016/j.jclinepi.2007.11.008 DOI: https://doi.org/10.1016/j.jclinepi.2007.11.008
11. Ingram DD, Franco SJ. 2013 NCHS Urban–Rural Classification Scheme for Counties. 2014.
12. Anderson RN, Rosenberg HM. Age standardization of death rates: implementation of the year 2000 standard. 1998.
13. National Cancer Institute. Joinpoint Regression Program. 2025.
14. Surveillance, Epidemiology, and End Results Program. Cancer Stat Facts: Pancreatic Cancer.
15. Tan JY, Wong HKK, Mee XC, Tan WY, Buss MK, Callahan MK, et al. Trends and Disparities in Location of Death Among Patients With Pancreatic Cancer. JCO Oncol Adv. 2025;2. https://doi.org/10.1200/OA-25-00018 DOI: https://doi.org/10.1200/OA-25-00018
16. Ramkumar N, Wang Q, Brooks GA, Tosteson ANA, Wong SL, Loehrer AP. Association of rurality with utilization of palliative care and hospice among Medicare beneficiaries who died from pancreatic cancer: A cohort study. J Rural Health. 2023;39(3):557–64. PMID: 36631820; PMCID: PMC10293103. https://doi.org/10.1111/jrh.12739 DOI: https://doi.org/10.1111/jrh.12739
17. Chawla M, Villarreal ME, Waterman BL, Di Tosto G, Gonzalez R, Sarna A, et al. Utilization of Palliative and Hospice Care Among Pancreatic Cancer Patients at an Academic Center. J Surg Res. 2023;289:22–6. PMID: 37075607. https://doi.org/10.1016/j.jss.2023.03.014 DOI: https://doi.org/10.1016/j.jss.2023.03.014
18. O’Brien J, Halsey B, Connors M, Deng M, Handorf E, Berardi G, et al. Palliative Care and End-of-Life Care in Metastatic Pancreatic Cancer. J Palliat Med. 2025;28(2):217–23. PMID: 39636708. https://doi.org/10.1089/jpm.2024.0313 DOI: https://doi.org/10.1089/jpm.2024.0313
19. Brooks GA, Tomaino MR, Ramkumar N, Wang Q, Kapadia NS, O’Malley AJ, et al. Association of rurality, socioeconomic status, and race with pancreatic cancer surgical treatment and survival. J Natl Cancer Inst. 2023;115(10):1171–8. PMID: 37233399; PMCID: PMC10560598. https://doi.org/10.1093/jnci/djad102 DOI: https://doi.org/10.1093/jnci/djad102
20. Ma S, Sokale IO, Thrift AP. Trends and Variations in Pancreatic Cancer Mortality Among US Metro and Nonmetro Adults, 1999–2020. J Clin Gastroenterol. 2024;58(6):627–31. PMID: 37983816. https://doi.org/10.1097/MCG.0000000000001929 DOI: https://doi.org/10.1097/MCG.0000000000001929
21. Segel JE, Hollenbeak CS, Gusani NJ. Rural–Urban Disparities in Pancreatic Cancer Stage of Diagnosis: Understanding the Interaction With Medically Underserved Areas. J Rural Health. 2020;36(4):476–83. PMID: 32710689. https://doi.org/10.1111/jrh.12498 DOI: https://doi.org/10.1111/jrh.12498
Data Availability Statement
The data that support the findings of this study are openly available in CDC‐WONDER at https://wonder.cdc.gov/. The data supporting the findings of this study were obtained from the CDC WONDER online database (Centers for Disease Control and Prevention Wide‐ranging Online Data for Epidemiologic Research). Further inquiries can be directed to the corresponding author
License
Copyright (c) 2026 Zuha Tariq, Alyaa Ahmed Ibrahim, Ahmed Khairy, Mohammad Rayyan Faisal, Abdelrahman Aly Mohamed, Rahemeen Goraya, Mahmoud Tablawy, Ibtissam ElGhazzani, Mohamed Ibrahim, Sihame ElGhazzani, Mahdi Ahmed, Ilhame ElGhazzani, Mohamed Zabady, Ahmed Atef Mohamed, Yara Refaii, Mohamed Fawzi Hemida
This work is licensed under a Creative Commons Attribution 4.0 International License.
Downloads
Published
Issue
Section
How to Cite
Article history
- Received
- 13 Mar 2026
- Received in revised form
- 18 May 2026
- Accepted
- 21 Jun 2026
- Published
- 23 Aug 2026
