Trends, disparities, and forecasts in co-recorded pancreatic cancer and cerebrovascular disease mortality in the United States, 1999–2024

Background: The population mortality burden associated with co-recorded pancreatic cancer and cerebrovascular disease (i.e., deaths in which both conditions are listed on the same death certificate) in the United States remains poorly characterized. We evaluated temporal, demographic, geographic, urbanization, and forecasted mortality trends. Methods: This retrospective population-based study used CDC WONDER Multiple Cause of Death data for adults aged 25 years or older from 1999 to 2024. Individuals younger than 25 years were excluded because pancreatic cancer mortality is extremely uncommon in this age group, resulting in sparse counts and unstable age-adjusted mortality estimates. Deaths were included when both conditions were listed as underlying or contributing causes. Age-adjusted mortality rates (AAMRs) were analysed using Joinpoint regression, and autoregressive integrated moving average models generated 10-year forecasts. Results: Overall, 22,085 deaths were identified. Annual deaths increased from 591 in 1999 to 1630 in 2024 while the AAMR increased from 0.32 to 0.56 per 100,000. Rates were stable from 1999 to 2013, then increased significantly through 2024 (annual percentage change, 6.26%; 95% confidence interval, 5.11–8.25). Mortality was higher among males, reaching 0.65 per 100,000 in 2024, and highest among non-Hispanic Black or African American individuals, at 0.87 per 100,000. Full-period AAPCs were significantly positive across all Census regions, with the highest 2024 AAMR in the Midwest at 0.57 per 100,000. Metropolitan and nonmetropolitan rates reached 0.45 per 100,000 by 2020. The overall AAMR was projected to reach 0.76 per 100,000 by 2034. Conclusions: US co-recorded pancreatic cancer and cerebrovascular disease mortality increased substantially after 2013, with persistent sex, racial, and geographic disparities.