{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T12:47:15Z","timestamp":1791809235746,"version":"4.3.4"},"reference-count":43,"publisher":"Wiley","issue":"19","license":[{"start":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T00:00:00Z","timestamp":1791417600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T00:00:00Z","timestamp":1791417600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["faseb.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["The FASEB Journal"],"published-print":{"date-parts":[[2026,10,15]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>National\u2010level data regarding population disparities and Type 2 Diabetes Mellitus (T2DM)\u2010specific mortality trends, using ICD\u201010 E11 and comparing pancreatic cancer deaths with versus without T2DM, remain incompletely characterized. This study aimed to analyze temporal trends and demographic\/geographic disparities in United States pancreatic cancer (PC)\u2009+\u2009T2DM mortality (1999\u20132020) to identify high\u2010risk populations and generate hypotheses for future targeted interventions. We analyzed death records with PC and T2DM from Wide\u2010ranging Online Data for Epidemiologic Research (CDC WONDER), calculating age\u2010adjusted mortality rates (AAMRs) and annual percent changes (APCs) across demographic and geographic strata. Concurrently, National Health and Nutrition Examination Survey (NHANES) 2007\u20132016 data were utilized to estimate the weighted prevalences of key behavioral risk factors (smoking, alcohol, high\u2010saturated\u2010fat diet). Among 17\u2009744 deaths, the age\u2010adjusted mortality rate (AAMR) for deaths with co\u2010listed PC and T2DM increased from 0.16 to 0.53 per 100\u2009000 population between 1999 and 2020, while mortality from PC without T2DM remained relatively stable. Adults aged 75\u201384 bore the highest absolute burden, whereas 45\u201354\u2010year\u2010olds showed the fastest recent increase. Hispanics had the fastest overall increase, Non\u2010Hispanic (NH) Whites experienced sharp recent acceleration, and NH Blacks maintained a heavy baseline burden. Geographically, the AAMR in 2020 was higher in nonmetropolitan than metropolitan areas, although the full\u2010period average annual percent change (AAPC) was higher in metropolitan areas. Among the four United States Census regions, the West had the highest AAMR in 2020 and the highest full\u2010period AAPC, whereas the South exhibited the fastest recent increase after 2014. Complementary NHANES data show distinct demographic patterns in behavioral risk factors (smoking, alcohol, high\u2010saturated\u2010fat diet) at the population level, providing contextual background for the observed mortality disparities. However, these general\u2010population estimates are not linked to the mortality cohort and serve only as descriptive context. Deaths with both pancreatic cancer and Type 2 diabetes mellitus recorded on death certificates increased substantially in the United States from 1999 to 2020, while mortality from PC without T2DM remained relatively stable. The coexisting burden is characterized by marked demographic and geographic disparities. While behavioral risk factors may contribute to these patterns, ecological comparisons cannot establish causation, and prospective studies are needed to evaluate targeted interventions such as smoking and dietary management, telehealth expansion, and policy\u2010level efforts to reduce financial barriers.<\/jats:p>","DOI":"10.1096\/fj.202602498r","type":"journal-article","created":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T15:01:43Z","timestamp":1791471703000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Trends in U.S. Mortality With Co\u2010Listed Pancreatic Cancer and Type 2 Diabetes, 1999\u20132020"],"prefix":"10.1096","volume":"40","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-7159-2435","authenticated-orcid":false,"given":"Hongxi","family":"Liu","sequence":"first","affiliation":[{"name":"The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine)  Hangzhou China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tiange","family":"Xing","sequence":"additional","affiliation":[{"name":"The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine)  Hangzhou China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qingyang","family":"Liu","sequence":"additional","affiliation":[{"name":"The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine)  Hangzhou China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wenjing","family":"Yu","sequence":"additional","affiliation":[{"name":"College of Life Science, Institute of Molecular Medicine Zhejiang Chinese Medical University  Hangzhou China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shiqi","family":"Zeng","sequence":"additional","affiliation":[{"name":"The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine)  Hangzhou China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xuefei","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Oncology Hangzhou TCM Hospital of Zhejiang Chinese Medical University (Hangzhou Hospital of Traditional Chinese Medicine)  Hangzhou China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leitao","family":"Sun","sequence":"additional","affiliation":[{"name":"The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine)  Hangzhou China"},{"name":"Key Laboratory of Neuropharmacology and Translational Medicine of Zhejiang Province, School of Pharmaceutical Sciences Zhejiang Chinese Medical University  Hangzhou China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leyin","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Oncology Hangzhou TCM Hospital of Zhejiang Chinese Medical University (Hangzhou Hospital of Traditional Chinese Medicine)  Hangzhou China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,10,8]]},"reference":[{"key":"e_1_2_13_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.hoc.2022.07.002"},{"key":"e_1_2_13_3_1","article-title":"Prevalence of Total, Diagnosed, and Undiagnosed Diabetes in Adults: United States, August 2021\u2010August 2023","volume":"516","author":"Gwira J. 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