D0006 - Mortality Associated With Pancreatic Malignant Tumors Is Improving but Incidence Continues to Rise

Tuesday, October 25, 2022

10:00 AM – 12:00 PM ET

Location: Crown Ballroom

Has Audio

Presenting Author(s)

Aun R. Shah, MD, MRCP

University of Nebraska Medical Center
Omaha, NE

Aun R. Shah, MD, MRCP¹, Ishani Shah, MD², Harmeet S. Mashiana, MD¹, Mohammad Bilal, MD³, Shifa Umar, MD⁴, Banreet S. Dhindsa, MD¹, Ishfaq Bhat, MD¹, Shailender Singh, MD¹
¹University of Nebraska Medical Center, Omaha, NE; ²Beth Israel Deaconess Medical Center, Boston, MA; ³University of Minnesota, Minneapolis VA Medical Center, Minneapolis, MN; ⁴Mayo Clinic, Rochester, MN

Introduction: Multiple guidelines have been proposed since 2006 for screening and surveillance of pancreatic neoplasms. However, effective screening strategies for pancreatic malignancies remain elusive. In this study we sought to identify any changes in incidence and mortality trends of pancreatic neoplasms after the introduction of pancreatic cancer screening guidelines.

Methods: Adult patients with a principal or secondary diagnosis of benign or malignant pancreatic neoplasm were selected from the National Inpatient Sample (NIS) database for the years 2007 to 2018. Yearly incidence of pancreatic benign and malignant tumors was calculated as well as trends of inpatient mortality for these patients. Secondary variables of interest included healthcare resource utilization [length of stay (LOS) and total hospitalization costs and charges]; as well as demographic variables and risk factors associated with pancreatic neoplasms.

Results: From 2007 to 2018, a total of 4616 patients were diagnosed with benign pancreatic tumors and 1,143,034 had malignant pancreatic tumors. There was an increase in the incidence of malignant pancreatic tumors by approximately 2.4% from 2007 to 2018; however, the annual mortality improved from 9.7% to 8.2% [p < 0.0001]. There was no significant variation in the incidence of benign pancreatic tumors or associated mortality [p < 0.31]. Mortality and healthcare utilization trends are summarized in Figure 1. The mean age for patients with malignant tumors was 67.9 years with no significant change in trends [p < 0.2]. From 2007 to 2018 the female preponderance for benign and malignant tumors decreased from 50.23% to 49.34% [p < 0.0001]. There was a significant increase in Medicare (56.4% to 58.3%) and Medicaid (6.2% to 7.9%) share as primary payer [p < 0.0001]. Risk factors associated with pancreatic malignancy also had a significantly rising trend.

Discussion: The incidence of malignant pancreatic tumors continues to rise. However, the associated mortality has been decreasing. Despite improving implementation of screening guidelines, there was no change in number of benign pancreatic lesions being diagnosed from 2007 to 2018. Risk factors associated with pancreatic malignancy continue to rise. These trends indicate the need for continued efforts for improved screening for early-stage pancreatic malignancies as well as stronger efforts to reduce risk exposure in high-risk patients.

Figure: Figure 1: Incidence, Mortality and Healthcare Utilization trends

Year	2007	2008	2009	2010	2011	2012	2013	2014	2015	2016	2017	2018	Total	p-value
Female (%)	50.23	50.93	49.74	49.09	51	48.91	48.77	49.29	48.69	48.25	48.4	49.18	49.34	< 0.0001
Race (%)														0.35
White	74.78	75.22	74.2	73.61	73.19	72.55	71.72	72.69	71.66	72.03	70.78	70.86	72.6
Black	11.82	11.29	11.65	14.38	13.32	13.53	14.11	13.48	14.13	13.64	14.17	13.76	13.38
Hispanic	6.98	7.02	7.33	6.98	7.97	7.68	7.91	7.8	7.91	7.72	7.92	8.69	7.72
Asian/Pacific islander	3.3	3.06	3.46	2.4	2.5	2.82	3.18	3.08	3.19	3.16	3.32	3.38	3.07
Native American	0.59	0.29	0.59	0.4	0.29	0.46	0.36	0.35	0.35	0.38	0.33	0.37	0.39
Other	2.53	3.12	2.77	2.22	2.73	2.96	2.72	2.6	2.77	3.08	3.47	2.94	2.84
Primary Expected Payer (%)														< 0.0001
Medicare	56.43	56.26	56.53	55.94	58.46	58.08	58.37	58.81	58.96	59.3	60.59	61.52	58.39
Medicaid	6.25	6.92	6.57	8.15	7.28	7.9	8.12	8.51	9.13	8.75	8.69	8.53	7.96
Private insurance	32.88	31.95	31.58	30.79	29.05	28.51	28.12	28.06	27.43	27.4	26.42	25.67	28.84
Self-pay	1.91	1.85	2.55	2.77	2.06	2.7	2.43	1.99	1.84	1.83	1.66	1.69	2.09
No charge	0.25	0.22	0.19	0.31	0.33	0.18	0.41	0.25	0.16	0.14	0.16	0.11	0.22
Other	2.27	2.81	2.57	2.04	2.81	2.63	2.54	2.38	2.47	2.58	2.48	2.49	2.51
Region of Hospital (%)														0.99
Northeast	25.1	23.41	21.7	24.15	21.26	22.51	22.69	22.67	21.77	22.52	22.61	21.4	22.6
Midwest	21.95	21.48	24.87	23.6	22.76	22.96	22.33	23.06	22.75	22.23	22.8	22.91	22.81
South	34.24	34.15	33.6	34.65	38.5	36.03	36.49	35.76	36.86	36.66	35.26	36.16	35.75
West	18.71	20.96	19.83	17.6	17.47	18.5	18.5	18.51	18.61	18.59	19.33	19.52	18.84
Type of hospital (%)														< 0.0001
Rural	9.88	9	12.41	11.74	10.83	12.03	11.65	15.22	14.03	14.9	14.83	15.91	12.84
Non-teaching urban	20.23	19.44	20.99	18.17	20.59	22.91	23.07	25.84	26.17	25.09	25.55	26.74	23.06
Teaching urban	69.89	71.56	66.6	70.09	68.58	65.06	65.28	58.94	59.79	60.01	59.62	57.36	64.1
Median Household income quartile (%)														0.11
$1-24,999	25.04	22.76	22.97	25.61	26.11	25.93	24.64	24.09	26.35	25.78	25.19	24.28	24.92
$25,000-34,999	22.49	26.41	25.76	23.77	23.11	23.54	25.04	27.03	23.46	24.43	24.94	25.54	24.65
$35,000-44,999	24.18	23.78	24.89	23.94	26.52	24.86	24.63	23.87	24.8	24.86	25.11	25.83	24.81
$45,000 or more	28.28	27.04	26.38	26.68	24.27	25.68	25.69	25.01	25.39	24.93	24.75	24.34	25.63
Alcohol Use disorder (%)	1.17	1.15	1.38	1.42	1.59	1.55	1.6	1.58	4.22	11.94	12.23	12.08	4.63	< 0.0001
Smoking Use disorder (%)	16.35	17.22	20.83	23.26	24.21	26.53	28.94	32.17	35.43	37.05	37.75	37.91	28.66	< 0.0001
Obesity (%)	2.54	3.15	4.1	4.36	4.98	5.89	6.05	7.21	7.45	6.6	7.4	7.86	5.74	< 0.0001
Chronic Pancreatitis (%)	2.2	2.39	2.09	2.77	2.21	2.54	2.63	2.49	2.65	2.37	2.63	2.93	2.5	0.17
Diabetes Mellitus (%)	31.49	32.05	35.3	34.95	36.43	37.11	37.16	38.01	38.25	39.43	40.58	40.42	36.96	< 0..0001

Table: Table1: Demographics and Risk factors

Disclosures:

Aun Shah indicated no relevant financial relationships.

Ishani Shah indicated no relevant financial relationships.

Harmeet Mashiana indicated no relevant financial relationships.

Mohammad Bilal indicated no relevant financial relationships.

Shifa Umar indicated no relevant financial relationships.

Banreet Dhindsa indicated no relevant financial relationships.

Ishfaq Bhat indicated no relevant financial relationships.

Shailender Singh indicated no relevant financial relationships.

Aun R. Shah, MD, MRCP¹, Ishani Shah, MD², Harmeet S. Mashiana, MD¹, Mohammad Bilal, MD³, Shifa Umar, MD⁴, Banreet S. Dhindsa, MD¹, Ishfaq Bhat, MD¹, Shailender Singh, MD¹. D0006 - Mortality Associated With Pancreatic Malignant Tumors Is Improving but Incidence Continues to Rise, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.