Abstract
<title>Abstract</title> <p> <underline> <bold>Background:</bold> </underline> This study's objective is to evaluate the 25-year mortality trends in the US population from pancreatic cancer that is exacerbated by alcoholism and smoking. Pancreatic cancer is still one of the deadliest tumors in the United States, despite improvements in detection and treatment. Its known modifiable risk factors include alcohol consumption and smoking, which account for around 20–30% and less than 5% of cases, respectively. Given that almost 80% of smokers also drink, these two characteristics typically overlap. Although both are classified as contributory causes of mortality, the precise combined burden of smoking and alcohol-related pancreatic cancer fatalities has not been fully characterized. <underline> <bold>Methodology:</bold> </underline> For people over 45 with pancreatic cancer (ICD-10: C25), concomitant alcohol abuse (F10), and smoking abuse (F17), data from the CDC WONDER database (1999–2023) was studied. Age, sex, race, Hispanic origin, U.S. Census area, and 2013 urbanization categories were used to stratify age-adjusted mortality rates (AAMRs) per 100,000. Joinpoint regression (JPR) analysis was used to determine annual percentage changes (APCs). The significance level was set at P <0.05. The Ljung-box test was used to assess the Autoregressive Integrated Moving Average (ARIMA: 1,1,0) models used to anticipate annual AAMRs through 2024. <underline> <bold>Results:</bold> </underline> Pancreatic cancer was the primary cause of 47,333 deaths in the US between 1999 and 2023; smoking and alcoholism were found to be contributory factors (overall AAMR = 14.09). By 2035, AAMR is predicted to be 30.61 with p = 0.91. Black people made up 10.94%, white people 87.23%, non-Hispanics 96.24%, and men 61.93%. Between 2001 and 2005, mortality increased significantly, with an APC of 63.96 (p=0.001). Males showed an even steeper significant rise from 2001 to 2004 with APC = 82.90, p<0.001, while females showed a dramatic significant surge from 2001 to 2005 with APC = 63.90 (p = 0.003). From 2001 to 2005, non-Hispanic people showed a sharply significant increase (APC = 65.21, p = 0.00). Significantly, the Northeast experienced a sharp increase between 2002 and 2004 (APC = 164.77, p<0.001). Among Urbanization categories, Medium Metro areas recorded the highest early APC =80.57, p = 0.003. White individuals showed a significant surge 2001–2005 (APC = 66.87, p = 0.0012. Highest AAMRs were in Delaware (66.7), Michigan (51.5) and Vermont (50.5); lowest in California (0.9), Alabama (9.4), and Georgia (11.4) <underline> <bold>Conclusion</bold> </underline> <bold>:</bold> The findings indicate that, despite notable demographic and geographic variations, mortality rates have remained high over the past 20 years and will continue to grow by 2035. In order to reduce the significant estimated future mortality toll, targeted campaigns and new legislative initiatives are essential. These findings call for increased cessation and prevention efforts countrywide. </p>