National trends in venous thromboembolism-related mortality among pancreatic cancer patients in the United States, 1999-2020.

BACKGROUND

Pancreatic ductal adenocarcinoma (PDAC) carries a high risk of venous thromboembolism (VTE), which significantly contributes to mortality. However, national trends in VTE-related deaths among this population remain poorly defined.

METHODS

We conducted a cross-sectional analysis of U.S. mortality data from 1999 to 2020 using the CDC WONDER platform. Deaths were included if VTE was the underlying cause and pancreatic cancer a contributing cause. Age-adjusted mortality rates (AAMRs) were calculated, and Joinpoint regression was used to assess temporal trends, with subgroup analyses by sex, race/ethnicity, age, region, urbanization level, and place of death.

RESULTS

A total of 20,373 VTE-related deaths occurred in pancreatic cancer patients. The overall AAMR was 0.36 per 100,000 population. A significant increase in mortality was observed, particularly from 2016 to 2020 (APC: 8.71%; p = 0.0039). Males had a higher AAMR than females (0.46 vs. 0.35). Black individuals experienced the highest mortality rate (0.62), followed by White (0.40) and Hispanic (0.36) populations. The burden increased sharply with age, peaking in the 75-84 age group (1.67). Geographic variation was notable, with the Midwest and West showing the highest AAMRs. Urban-rural differences were minimal, though trends rose in both settings. One-third (31.4%) of deaths occurred at home, highlighting potential gaps in outpatient management and end-of-life care.

CONCLUSION

VTE-related mortality in pancreatic cancer is rising, with disproportionate effects on older adults, males, and Black individuals. These findings highlight the need for tailored prevention strategies, equitable care access, and better integration of palliative services.