Disparities in pancreatic cancer and sepsis-related mortality: Insights from a 21-year nationwide analysis (1999–2020).

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243 Background: Patients with pancreatic cancer (PC) are highly vulnerable to sepsis due to advanced malignancy and immunosuppressive therapies. While sepsis is a major contributor to cancer-related mortality, its impact on solid tumors like pancreatic cancer remains underexplored. This study analyzes national trends in sepsis-related mortality among these patients using population-level data. The goal is to fill a critical knowledge gap and guide targeted interventions. Methods: Mortality trends in pancreatic cancer adults due to septicaemia aged ≥25 years were analyzed using the CDC WONDER database, identifying through ICD-10 codes C25 “Pancreas Malignant Neoplasms” and A41 “Septicaemia”. Age-adjusted mortality rates (AAMRs) per 100,000 population and crude rates were extracted. Joinpoint regression was used to calculate annual percent changes (APCs) with 95% confidence intervals (CI). Results: Between 1999 and 2020, 4,466,536 documented deaths were attributed to septicaemia among PC individuals. The overall AAMR initially declined from 93.1 in 1999 to 89.3 in 2012 (APC: –0.19%; 95% CI: –1.41% to 0.21%), followed by an increase to 107.2 in 2020 (APC: 1.46%; 95% CI: 0.67% to 4.29%). Males had consistently higher AAMRs than females (125 vs 92.9). Among men, AAMRs decreased from 107.7 (1999) to 101.7 (2012), then rose to 125.0 (2020; APC: 1.78%; 95% CI: 0.91% to 4.60%). AAMRs in women rose steadily from 82.8 (1999) to 92.9 (2020). The non-Hispanic (NH) Black or African American (AA) population has the greatest AAMR (162.3), followed by the NH American Indian or Alaska Native with AAMR (148.7) and the Hispanic or Latino (113.1). The lower-risk populations were the NH White population with AAMR (100.5) and the NH Asian or Pacific Islanders with AAMR (70.8). AAMR also varied by region (South: 119.1; Midwest: 104.7; Northeast: 99.9; West: 94.9), and non-metropolitan areas had higher AAMR (non-core areas: 120.8; micropolitan: 118.8; small metro: 111.6) than metropolitan areas (large central metropolitan: 105.2; large fringe areas: 99.1).The states in the upper 90th percentile of AAMRs were Oklahoma, Arkansas, Louisiana, Mississippi, Alabama, Tennessee, Kentucky, Texas, exhibited nearly double the rates compared to states falling in the lower 10th percentile, i.e. Oregon, Idaho, Colorado, Arizona, Alaska, and Minnesota. Conclusions: Mortality rates from septicaemia among adults with pancreatic cancer have risen in the United States over the past two decades. Significant disparities persist across sex, race, geography, and urbanicity. These findings underscore the urgent need for targeted public health strategies, early sepsis detection protocols, and equitable care delivery to mitigate preventable deaths in this high-risk population.

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