P4354 - Epidemiology and Projected Trends of Stroke Mortality in Pancreatic Cancer: A CDC WONDER Database Study

Usama Sakhawat, MD¹, Ali Zubair, MBBS², Erum Siddiqui, MBBS³, Sana Altaf, MBBS⁴, Allah Dad, MD⁵, Muhammad Arham, ⁶, Kinza Bakht, MBBS⁷, Faizan Ahmad, MD⁸, Tehmasp Rehman Mirza, MBBS⁹, Faseeh Haider, MD¹⁰, Fatima Binte Athar, MBBS¹¹, Rama Hassan, MBBS¹², Muhammad Ahmed, MD¹, Ahmed Shehadah, MD¹³, Amanke Oranu, MD¹³
1United Health Services, Wilson Medical Center, Johnson City, NY; 2Sheikh Zayed Medical College Raheem Yar Khan, Lahore, Punjab, Pakistan; 3Jinnah Sindh Medical University, Karachi, Pakistan, Karachi, Sindh, Pakistan; 4Deccan College of Medical Sciences, Irving, TX; 5Shiekh Zayed Medical College Rahim Yar Khan, Pakistan, Kot Addu, Punjab, Pakistan; 6Sheikh Zayed Medical College, Pakistan, Rahim Yar Khan, Punjab, Pakistan; 7Sheikh Zayed Medical College Rahim Yar Khan, Muzaffargarh, Punjab, Pakistan; 8Duke University, Durham, NC; 9MBBS, Lahore, Punjab, Pakistan; 10Allama Iqbal Medical college, Lahore, Punjab, Pakistan; 11Karachi Medical And Dental College, Karachi, Sindh, Pakistan; 12Akhtar Saeed Medical and Dental College, Lahore, Binghamton, NY; 13United Health Services, Wilson Medical Center, Binghamton, NY

Introduction: Pancreatic cancer patients face a 2.5 fold higher risk of stroke compared to the general population due to hypercoagulability, tumor related factors, and treatment effects. Understanding mortality trends in this population is critical for improving clinical management and public health strategies. This study examines stroke related deaths among pancreatic cancer patients in the U.S. from 1999 to 2023, analyzing temporal, demographic, and geographic trends, and forecasts future mortality through 2030.

Methods: Mortality data were extracted from the CDC WONDER database utilizing multiple causes of mortality dataset with ICD 10 codes for pancreatic cancer (C25.0–C25.9) and stroke (I60–I69). Age adjusted mortality rates (AAMR) were calculated per million population. Joinpoint regression identified temporal trends, estimating annual percentage changes (APC) in mortality. Stratified analyses were conducted by sex, race/ethnicity, census region, state, and urbanization status. An ARIMA(4,0,0) model forecasted mortality trends through 2030.

Results: From 1999 to 2023, 16,547 stroke related deaths occurred among pancreatic cancer patients. Mortality initially declined (1999–2015; APC = 0.999%, p = 0.0012) but surged sharply thereafter (2015–2023; APC = +8.116%, p < 0.0001), reaching 22.0 deaths/million in 2023. Sex stratified analyses revealed similar trends, with males experiencing higher mortality (25.7 vs. 19.2 deaths/million in 2023). Geographically, the Midwest had the highest 2023 AAMR (24.6 deaths/million), while the West showed the steepest increase (APC = +9.25%, p < 0.0001). Racial disparities were evident: Black individuals had the highest peak mortality (34.5 deaths/million in 2023), while Hispanic populations saw delayed but significant increases (APC = +7.71%, p = 0.002). Urban rural differences emerged, with non metro areas experiencing sharper rises post 2014. Forecasts predict a gradual decline post 2023, reaching 15.16 deaths/million by 2030.

Discussion: Stroke related mortality in pancreatic cancer patients has risen alarmingly since 2015, with disparities across sex, race, and region. The COVID 19 pandemic exacerbated these trends. While forecasts suggest a potential decline, sustained public health interventions particularly in high risk populations are urgently needed to mitigate this burden. Further research should explore underlying mechanisms, including thromboembolic risks and healthcare access disparities.


Figure: Central Illustration, Forecasted Trends (2021-2030)

Disclosures:
Usama Sakhawat indicated no relevant financial relationships.
Ali Zubair indicated no relevant financial relationships.
Erum Siddiqui indicated no relevant financial relationships.
Sana Altaf indicated no relevant financial relationships.
Allah Dad indicated no relevant financial relationships.
Muhammad Arham indicated no relevant financial relationships.
Kinza Bakht indicated no relevant financial relationships.
Faizan Ahmad indicated no relevant financial relationships.
Tehmasp Rehman Mirza indicated no relevant financial relationships.
Faseeh Haider indicated no relevant financial relationships.
Fatima Binte Athar indicated no relevant financial relationships.
Rama Hassan indicated no relevant financial relationships.
Muhammad Ahmed indicated no relevant financial relationships.
Ahmed Shehadah indicated no relevant financial relationships.
Amanke Oranu indicated no relevant financial relationships.

Usama Sakhawat, MD¹, Ali Zubair, MBBS², Erum Siddiqui, MBBS³, Sana Altaf, MBBS⁴, Allah Dad, MD⁵, Muhammad Arham, ⁶, Kinza Bakht, MBBS⁷, Faizan Ahmad, MD⁸, Tehmasp Rehman Mirza, MBBS⁹, Faseeh Haider, MD¹⁰, Fatima Binte Athar, MBBS¹¹, Rama Hassan, MBBS¹², Muhammad Ahmed, MD¹, Ahmed Shehadah, MD¹³, Amanke Oranu, MD¹³. P4354 - Epidemiology and Projected Trends of Stroke Mortality in Pancreatic Cancer: A CDC WONDER Database Study, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.