Burden of pancreatic cancer in China and the United States, 1990–2023
Pancreatic cancer (PC) remains a major global health burden characterized by high mortality and substantial socioeconomic inequality. This study compared long-term trends, inequality patterns, and risk-factor transitions of PC burden in China and the United States from 1990 to 2023. Using Global Burden of Disease Study (GBD) 1990–2023 data, we analyzed incidence, prevalence, mortality, and disability-adjusted life years (DALYs) of PC. Temporal trends were assessed using Joinpoint regression analysis, calculating annual percent changes (APCs) and average annual percent changes (AAPCs). Socioeconomic inequalities were evaluated using the slope index of inequality (SII) and concentration index (CIX). Population attributable fractions (PAFs) were used to quantify major risk factors. In 2023, China had more cases than the United States (103,000 vs. 66,000) but lower age-standardized prevalence (4.51 vs. 11.19), incidence (5.13 vs. 10.53), mortality (4.97 vs. 9.56) and DALYs per 100,000. From 1990 to 2023, burden increased in both countries, although age-standardized DALYs declined slightly in China (AAPC −0.15%) and increased in the United States (0.12%). Burden peaked at 60–74 years in China and shifted to older ages in the United States. Sex differences diminished with age and became non-significant in the oldest age groups. Globally, the burden remained concentrated in high socio-demographic index (SDI) with widening inequality. High fasting plasma glucose surpassed tobacco use as the leading attributable risk factor in the United States and became a major contributor in China. China had a higher absolute burden but lower age-standardized rates (ASR) than the United States. The United States burden was more concentrated in older age groups, while the global burden remained concentrated in high-SDI regions with widening inequality. Rising high fasting plasma glucose underscores the need for metabolic risk management in PC prevention.