Global Burden of Disease Study 2019 Indicates That Smoking Gradually Becomes a Key Driver of the Burden of Pancreatic Cancer in Developing Regions

Abstract

Pancreatic cancer (PC) remains a high mortality disease worldwide with a 5-year survival rate of less than 10%. Economic and living standard improvements in developing countries have significantly raised behavioral and metabolic risk factors of PC-related burden over the past decades. However, previous studies have not fully clarified how these risk factors contribute to PC over time. By employing the Global Burden of Disease (GBD) Study 2019, we examined PC-associated burden and its related risk factors from 1990 to 2019 in the present paper. During that time frame, the number of PC death cases significantly increased throughout the world; and developing regions have a higher trend compared to developed regions. Smoking, high fasting plasma glucose (FPG), as well as high body mass index (BMI) have become significant drivers of PC burden, which has also contributed to the rise in PC-related deaths in developing countries. Meanwhile, the rapid increase in premature deaths in developing countries should draw the public’s attention. It is therefore necessary to intervene on the PC-associated risk factors to significantly reduce death cases and burden. The renewal of PC burden analysis in this paper at multiple levels in GBD database is very beneficial for each country to determine individual policies to control the increasing trend of this disease.

1. Introduction

Pancreatic cancer (PC) is an aggressive malignancy arising from the pancreas with a poor prognosis, and its risk factors include smoking, pancreatitis, alcohol use, and a cluster of metabolic conditions such as obesity, hypertension, dyslipidemia, insulin resistance, and type 2 diabetes mellitus [1, 2, 3]. Currently, PC is the fourth leading cause of cancer-related deaths in Western societies, and it is predicted to be the second leading cause of cancer-related mortality in America in 2030 [4, 5]. Over the past decades, the rapid improvement of economy and living standards in developing countries has notably caused the promotion of metabolic risk factors (e.g., high fasting plasma glucose (FPG) and body mass index (BMI)) incidences) [6, 7, 8]. In addition, tobacco smoking is a rich and poisonous mixture that causes various diseases via multiple mechanisms, especially cancers [9, 10]. Therefore, the effects of these risk factors on PC-related death cases over time warrants investigation, and it is also gradually becoming significantly urgent for PC prevention in developing countries.

In order to prevent and manage PC, it is pivotal to obtain and analyze detailed and comparable epidemiological estimates for PC by geography, year, age, and sex, as well as the related risk factors. Global Burden of PC collaborators have shown a global overview of the epidemiology and risk factors of PC; however, PC burden has not been well understood on a worldwide scale as far as we know [11, 12, 13]. Therefore, our team summarized and further analyzed the PC-related burden between 1990 and 2019 in this paper by using the data reported in the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019. Moreover, we show the results of PC-related burden in different sex and age groups and its associated burden and risk factors at global, regional, and national levels. In short, we found that PC-associated death cases significantly increased from 1990 to 2019, and high FPG and BMI as well as smoking contribute to the age-standardized death rate (ASDR) increase in low sociodemographic index (SDI) regions. Therefore, the present paper may provide critical suggestions for developing available preventive measures to decrease the PC burden around the world.

2. Methods

2.1 Data source

The 2019 GBD study provides updated and detailed burden estimates of diseases, injuries, and related risk factors at global, regional, and national levels through integrating all available data around the world. Global Health Data Exchange (GHDx) query tool is maintained by the Institute for Health Metrics and Evaluation, and it encompasses available data on over 369 human pathologies and 87 attributable risk factors, obtained from 204 different countries and territories [14, 15]. In the present paper, annual numbers and ASDRs of PC-related deaths, disability-adjusted life years (DALYs), years of life lost (YLLs), years of life lived with disability (YLDs), and incidence and prevalence rates from 1990 to 2019 were obtained via the GHDx query tool (http://ghdx.healthdata.org/gbd-results-tool).

2.2 Attributable burden estimation

Estimation methods in this paper have been described in detail in previous research [15, 16]. The natural logarithm of ASDR assumes linearity over time; therefore, Y = α + βX + ε, where Y equals ln (ASDR), X equals calendar year, and ε equals error term; and ASDR’s estimated annual percentage change (EAPC) was counted via the “100 × (exp(β) -1)” formula [17, 18]. Having a positive EAPC indicates that the trend of the ASDR is increasing, and having a negative EAPC indicates a decreasing trend for the ASDR. Additionally, the change from 1990 to 2019 in data has been counted by using the formula as follows: (the certain data in 2019 – the certain data in 1990)/the certain data in 1990) × 100%. Also, all countries are divided into 5 SDI quintiles: high-, high-middle-, middle-, low-middle- and low-SDI regions, and they are also categorized into 17 GBD regions based on their different geographies. Moreover, we artificially divide these populations into 4 age groups in this paper: youth (15–44 years), middle-aged (45–59 years), middle-old-aged (60–74 years) and old-aged (75+ years); and summarize the data of each group as a new age group [16].

3. Results

3.1 Developing regions have a higher EAPC of PC-related death cases

The PC-associated health burden is showed as death cases and DALYs (YLL and YLD), and these indexes all remarkedly elevated from 1990 to 2019. Briefly, the total number of PC death cases ascended gradually from 0.198 million (95% uncertainty interval [UI]: 0.189–0.205) in 1990 to 0.531 million (95% UI: 0.492–0.567) in 2019 (Figure 1a; Table 1). Notably, PC-related death cases substantially up-regulated in high and high-middle SDI regions from 1990, reaching respectively 0.190 (95% UI: 0.171–0.201) and 0.160 million (95% UI: 0.146–0.171) in 2019 (Figure 1b; Table 1). Moreover, the number of DALYs ascended from 4.648 million (95% UI: 4.465–4.812) in 1990 to 11.549 million (95% UI: 10.777–12.339) in 2019, and the PC-related YLL and YLD incidence and prevalence also significantly increased as similar as DALYs (Figure 1a and b). PC is still a tumor worthy of special attention around the world, especially in the developed regions. However, the change in disease-associated deaths may result in the alteration of overall disease burden. The value of ASDR progressively increased (5.338 [95% UI: 5.522–5.067] per 100,000 population in 1990 and 6.618 [95% UI: 6.114–7.063] per 100,000 population in 2019 at the global level during the past three decades; and the estimated annual percentage change (EAPC) is 0.008 (Figure 1c; Table 1). In addition, EPAC of PC-related ASDR respectively is 0.005, 0.007, 0.020, 0.024, and 0.017 in high, high-middle, middle, middle-low and low SDI regions, which suggested that the EPAC of PC burden in developing regions had exceeded that in developed regions during the past 30 years.

Figure 1.

Developing regions have a higher EAPC of PC-related death cases. (a) PC-related death cases at global level in 1990–2019; (b) PC-related deaths cases globally and in different SDI regions between 1990 and 2019; (c) PC-related ASDRs globally and in different SDI regions in 1990–2019; (d) PC-related ASDRs in all countries and territories from 1990 to 2019; (e) annual changes of PC-related ASDRs in all countries and territories in 1990–2019.

	1990		2019		1990–2019
Characteristics	Number of deaths (95% UI)	ASDR per 100,000 (95% UI)	Number of deaths (95% UI)	ASDR per 100,000 (95% UI)	EAPC of ASDR
Global	198,050.9 (189,328.9–204,762.6)	5.337988 (5.066576–5.521704)	531,107.1 (491,948.2–566,536.9)	6.617711 (6.114269–7.062683)	0.008
Sex
Males	103,311.8 (98,381.2–108,763.8)	6.117671 (5.811734–6.418189)	278,173.5 (257,504.9–298,745)	7.549512 (7.00679–8.093687)	0.008
Females	94,739.13 (89,322.34–98,183.68)	4.638661 (4.341669–4.816422)	252,933.6 (225,846.2–273,819.7)	5.765981 (5.149236–6.242311)	0.007
Sociodemographic index
Low	3732.25 (2986.98–4466.39	1.706752811 (1.354595014–2.043574753)	12,945.68 (11,335.87–14,668.86)	2.719237 (2.382481–3.088279)	0.017
Low-middle	10,534.08 (8989.17–11,991.20)	1.912891 (1.620578–2.179905)	48,531.94 (44,310.31–53,080.10)	3.753841 (3.436528–4.087937)	0.024
Middle	27,839.57 (25,926.03–29,774.69)	2.873963 (2.681809–3.060948)	120,021.02 (107,034.53–134,529.10)	5.028165 (4.481748–5.633189)	0.020
High-middle	66,078.52 (63,329.31–68,573.69)	6.368478 (6.085345–6.608387)	159,583.34 (146,076.68–170,901.98)	7.842302 (7.173386–8.404491)	0.007
High	89,795.20 (85,585.16–91,855.04)	8.523968428 (8.120608505–8.7211042)	189,782.35 (171,237.17–200,954.96)	9.642343 (8.829988–10.15834)	0.005
Region
African Union	6495.03 (5660.48–7273.16)	2.470063 (2.146529–2.789471)	24,507.33 (21,894.36–27,722.39)	4.269341 (3.833127–4.795673)	0.018
Central Europe, Eastern Europe, and Central Asia	32,988.71 (31,723.09–34,386.87-)	6.995463 (6.710744–7.293639)	55,073.43 (50,226.10–59,699.96)	8.736954 (7.972693–9.458667)	0.006
Commonwealth	24,090.01 (22,069.40–25,875.86)	3.33998 (3.068543–3.58272)	76,609.06 (70,607.06–82,887.01)	4.269969 (3.921841–4.613284)	0.008
European Union	59,527.67 (57,110.58–60,782.32)	8.566903 (8.216116–8.749479)	108,799.82 (99,209.44–115,700.88)	9.904503 (9.161547–10.47891)	0.006
Four World Regions	197,890.67 (189,177.16–204,596.72)	5.342123 (5.070414–5.52598)	530,364.46 (491,286.88–565,716.10)	6.618569 (6.115779–7.063628)	0.008
G20	172,093.47 (164,304.22–177,507.19)	6.004115 (5.6873–6.205645)	440,507.51 (407,220.42–469,488.84)	7.126603 (6.569833–7.599675)	0.006
High-income	104,195.34 (99,468.66–106,572.21)	8.606354 (8.21392–8.801198)	213,898.08 (193,069.89–225,910.35)	9.691574; (8.905589–10.17949)	0.005
Latin America and Caribbean	9087.31 (8727.74–9322.18)	4.328772 (4.126848–4.454814)	33,958.87 (30,743.65–37,037.14)	5.900684 (5.338953–6.435645)	0.010
Nordic Region	3577.05 (3395.57–3691.19)	9.326386 (8.866859–9.612517)	5503.46 (5032.12–5862.14)	9.634676 (8.902379–10.24815)	0.001
North Africa and Middle East	4593.99 (3889.31–5424.34)	2.839286 (2.373719–3.362284)	22,277.14 (19,357.44–25,691.38)	5.491246 (4.784293–6.309636)	0.024
OECD Countries	113,507.83 (108,274.30–116,056.64)	8.515677 (8.115832–8.711694)	234,652.44 (212,197.36–248,342.99)	9.515365 (8.752035–10.0171)	0.004
South Asia	7736.11 (6242.63–9124.89)	1.524468 (1.21814–1.814484)	40,012.02 (35,017.30–45,582.35)	3.039063 (2.650421–3.451983)	0.024
Southeast Asia, East Asia, and Oceania	34,369.13 (30,550.47–38,437.22)	3.146132 (2.806709–3.483381)	148,207.46 (129,127.02–169,171.49)	5.676818 (4.950982–6.466765)	0.022
Sub-Saharan Africa	5080.33 (4372.88–5745.32)	2.610513 (2.238488–2.971409)	17,680.11 (15,687.82–19,936.27)	4.251351 (3.798545–4.736339)	0.016
WHO region	197,567.19 (188,860.68–204,272.86)	5.342985 (5.070932–5.527481)	529,380.03 (490,437.58–564,548.47)	6.62151 (6.119083–7.067508)	0.008
World Bank Income Levels	197,979.05 (189,259.93–204,688.94)	5.338855 (5.06738–5.522642)	530,862.92 (491,721.96–566,270.72)	6.618082 (6.114564–7.063045)	0.008
World Bank Regions	197,855.78 (189,125.74–204,570.94)	5.338191 (5.066414–5.521968)	530,520.51 (491,420.33–565,885.29)	6.616384 (6.113325–7.061656)	0.008

Table 1.

The death cases and age-standardized death rates of PC in 1990 and 2019, and their temporal trends from 1990 to 2019.

As shown in Table 1, we found that PC-related death cases and ASDRs remarkedly ascended from 1900 to 2019 in most GBD regions. Briefly, the relatively high SDI regions including the European Union (9.904503 [95% UI: 9.161547–10.47891]), high-income (9.691574 [95% UI: 8.905589–10.17949]), the Nordic region (9.634676 [95% UI: 8.902379–10.24815]) and OECD countries (9.515365 [95% UI: 8.752035–10.0171]) have higher ASDR. Furthermore, ASDRs of PC increased in all GBD regions, with the maximum increase being surveyed in North Africa and Middle East (EAPC = 0.024), followed by South Asia (EAPC = 0.024), Southeast Asia, East Asia, and Oceania (EAPC = 0.022). However, relatively high SDI regions, such as the Nordic region (0.001), OECD countries (0.004) and high-income (0.005), have the lowest EAPC with higher ASDR. An extremely high ASDR was observed in Greenland (19.29 [95% UI: 15.73–22.84]), and its value was far ahead of that in other countries. On the contrary, the lowest ASDRs were found in Ethiopia, Somalia, and Papua New Guinea, with rates of 1–2 per 100,000 population in 2019 (Figure 1d). At the country level, Cabo verde (7.45%), Grenada (5.85%), Kazakhstan (5.74%), Dominica (5.23%), and Saint Kitts and Nevis (5.17%) had the most pronounced increases in ADSR. Interestingly, ASDRs of some developed countries in Northern Europe dropped slightly from 1990 to 2019, although most countries have obvious increases in ASDRs. For instance, Colombia, Sweden, Somalia, Iceland, and Ireland had marked decreases in ASDR; their annal percent changes are −0.54%, −0.36%, −0.29%, −0.27%, and −0.25%). As the largest developing country, current ASDR in China is 5.99 [95% UI: 5.12–6.93], with a relatively high increase in annal percent change of ASDR (2.02%) (Figure 1e).

3.2 Sex differences in PC-related burden may further decrease

As shown in Table 1, PC-associated death cases at the global level significantly up-regulated in both males and females from 1990 to 2019, and it respectively reached 0.278 (95% UI: 0.258–0.299) million in males and 0.253 (95% CI: 0.226–0.274) million in females in 2019, which also showed that men had incessantly higher mortality than women in PC burden. Similarly, males had higher ASDRs than females, and the highest (males vs. females = 11.099390 vs. 8.307626) and lowest (males vs. females = 2.946914 vs. 2.499140) ASDRs were separately found in high and low SDI regions (Figure 2a). It is worth noting that the ASDR alterations in women increased more notably than in men during the past three decades in “Low SDI” and “Low-middle SDI” regions (Figure 2b), resulting in decreases in the ASDR ratio of men to women, and they had reached approximately 1.18 and 1.10, respectively, in 2019 (Figure 2c). In the 17 GBD regions, ASDR of male outweighed that of female in most regions except the Nordic region (Figure 2d). Males had higher PC death cases than females with diminishing differences in sex, and thereby, the higher increase of PC-related deaths in females is a matter worthy of attention, especially in developing regions.

Figure 2.

Sex differences in PC-related burden may further decrease. (a) PC-related ASDRs in males and females globally and in different SDI regions in 1990–2019; (b) percent changes of PC-related ASDRs in males and females globally and in different SDI regions between 1990 and 2019; (c) the ratios of male to female globally and in different SDI regions in 1990–2019; (d) PC-related ASDRs in males and females globally and in 17 GBD SDI regions between 1990 and 2019.

3.3 Developing regions have a higher rate of premature death in PC

Figure 3a illustrates that PC-related deaths tended to increase with age, with the 65–69, 70–74, 65–69, 70–74, and 75–79 age populations having the highest death cases in low, low-middle, middle, high-middle, and high SDI regions, respectively. Moreover, we artificially divided these populations into different age groups: youth, middle-aged, middle-old-aged and old-aged; and then analyzed each group’s respective death rates in every SDI region and compared them. At the global level, there was the greatest up-regulation in death cases in the old-aged populations from 1990 to 2019 (Figure 3b). As a result, the number of deaths in 75+ groups increased more rapidly in low-middle SDI regions between 1990 and 2019 than in other SDI regions, as well as the number of youth deaths in low SDI regions increased faster than in other SDI regions. On the contrary, death cases in some developed regions, such as European Union, High-income and the Nordic region, had obvious declines in the youth groups from 1990 to 2019 (Figure 3b). In addition, a trend toward older ages was evident in the population who died from PC-associated causes from 1990 to 2019, and there were more elderly individuals who died from PC in high SDI regions than in low SDI regions (Figure 3c). According to data from 1990 and 2019, low SDI regions had the youngest distribution of PC-related deaths, and the proportions of patients under 60 years were 33% and 31% in 1990 and 2019, respectively. By comparison, the age distribution of death rates for PC-related deaths was the highest for high SDI regions, with elderly individuals accounting for 42% in 1990 and 50% in 2019. Accordingly, deaths related to PC in developing regions are not only increasing faster than those in developed regions but also affecting younger populations (at ages 15–44 years), which is a relatively serious problem.

Figure 3.

Developing regions have a higher rate of premature death in PC. (a) the distribution of PC-related death cases at different age groups globally and in different SDI regions from 1990 to 2019; (b) percent changes in PC-related death cases in four age groups between 1990 and 2019 globally and in different SDI regions; (c) percentages of PC-related death cares at four age groups globally and in different SDI regions between 1990 and 2019.

3.4 The burden of PC death is partly due to the poor control of smoking, FPG, and BMI

As shown in Figure 4a, the risk factors including high metabolic risk factors (BMI and FPG) and behavioral risk factor (smoking) attributable to ASDRs of PC changed by 51.6%, 66.9%, and − 1.00%, respectively, from 1990 to 2019. The smoking risk factor, however, remained the leading cause of ASDR increase in 2019, and it was also the top factor contributing to ASDRs in all SDI regions. Smoking-related mortality has declined substantially in high SDI countries, but it remains an important risk factor with a high ASDR value of 2.37 per 100,000 in 2019. In contrast, ASDRs attributable to high BMI and FPG significantly increased in all SDI regions. Smoking and high FPG risk factors contributed to the higher ASDR among men than women worldwide. For smoking, the sex ratio (male to female) was greater than 1.8, suggesting that this risk was still a key contributing factor to the differences in PC-caused death rates. The smoking risk factor was associated with a significant decline in deaths in other SDI regions across all age groups; however, an increase in this parameter was observed in the middle SDI region over the same period (Figure 4b). At the geographical level, developing regions including North Africa, Middle East, South Asia, Southeast Asia, East Asia, and Oceania exhibited the fastest growth in high BMI and FPG-attributed death rates at all ages (Figure 4c). In sharp contrast, developed regions, such as the Nordic region, OECD countries, and high-income regions showed minimal increases. As a result, metabolic risk factors pose major challenges to reducing PC-related deaths throughout the world, but especially in developing nations. The smoking rate has declined in youth groups in the following locations: Nordic region, OECD countries, and high-income regions; and Southeast Asia, East Asia, and Oceania were the regions with the highest growth rate in PC-related death cases over this time.

Figure 4.

The burden of PC death is partly due to the poor control of smoking, FPG and BMI. (a) PC-related ASDRs attributable to smoking, FPG and BMI globally and in different SDI regions in 1990–2019; (b) the ratios of male to female of PC-related ASDRs attributable to smoking, FPG and BMI globally and in different SDI regions in 1990–2019; (c) the percent changes in PC-related death cases attributable to smoking, FPG and BMI globally and in different SDI regions in 1990–2019.

4. Discussion

PC remains a high mortality disease worldwide with a 5-year survival rate of less than 10%, and metabolic risk factors and smoking tobacco have been largely responsible for increasing the mortality rate of this cancer in recent decades [19, 20]. The present study, in terms of our understanding, is the latest analysis of PC-associated burden and risk factors at the global level. Researchers have shown that the PC-caused burden is similar to the overall cancer burden trend [21, 22]. Across the world, this study found that the absolute number of PC-related deaths increased from 0.198 million in 1990 to 0.531 million in 2019. Further, the global ASDR of PC has shown a gradual increase in the past 30 years, suggesting that population increase and aging may be responsible for the up-regulation in death cases. Additionally, the ASDR trend value can serve as an indicator reflecting changes in disease patterns and risk factors, so we used the EAPC index of ASDR to reflect such changes in the last three decades [23, 24, 25]. The results showed that ASDR was up-regulated from 1990 to 2019 along with SDI’s improvement; briefly, EPAC of PC-related ASDR was 0.005, 0.007, 0.020, 0.024, and 0.017 in high, high-middle, middle, middle-low, and low SDI regions, respectively. During the past three decades, developing regions have had a greater EPAC of PC burden than developed regions.

It is worth noting that high FPG and BMI as well as smoking have become the primary drivers of PC-induced burden, and the inability to manage these factors has led to an increase in the mortality rate in lower SDI regions compared to improved SDI regions. As a result of economic growth, developed regions, such as the European Union and the United States, have also seen increases in metabolic disease incidence. There has been a significant decline in the mortality rate associated with metabolic risk factors as a result of decades of strengthening health promotion guidelines in developed countries [26, 27, 28]. Moreover, tobacco smoking is the major cause of avoidable premature mortality, and it results in various diseases, such as lung, pancreatic, and oropharynx cancers, as well as apoplexia and coronary heart disease. Importantly, smoking has gradually decreased in many developed countries due to the effective policies to combat tobacco use; but the developing countries are still at risk because of the aggressive strategies of lucrative tobacco companies [29, 30]. PC-related death cases have substantially increased over recent decades in developing regions including North Africa, Middle East, South Asia, Southeast Asia, East Asia, and Oceania. In China, for example, PC is estimated to affect over 0.117 million people in 2019. As a result of rapid economic transformation, industrialization, and urbanization in these regions, diet and lifestyle have changed significantly, which has exacerbated the rise of metabolic diseases and smoking-related diseases [31, 32, 33]. It is therefore imperative to take effective steps to slow the adverse trend in developing regions.

As part of this study, we further found that male PC deaths and ASDRs are higher than female deaths and that the gap between male and female PC deaths has decreased. In addition to biological factors, smoking risk factors and BMI may also contribute to gender-based differences [34, 35]. Smoking-related ASDRs are notably higher in males, which indicates that smoking is an important risk factor leading to gender differences in PC-caused death burden. The analysis of the ASDR ratio between men and women in high SDI regions indicates that the contribution of high FPG has exceeded smoking, which is the most important risk factor in other SDI regions. Therefore, it is necessary to increase awareness of these risk factors and improve corresponding management to further decline sex-specific differences in PC mortality. In addition, further consideration should be taken to reflect changes in the burden of PC-related deaths among populations at different life stages, and this paper thereby investigated the percentage change in death cases in four artificially divided age groups: youth, middle-aged, middle-old-aged, and old-aged. Globally, most deaths from PC are caused by people aged 60–74 years; however, the majority in high SDI region is mainly caused by people 75 years and older perhaps because of medical progress and population aging. The number of premature deaths (15–44 years) has increased significantly over the past three decades, except for in some developed areas, such as the European Union, high-income countries, and the Nordic region. Based on these opposite trends, developed and developing countries show a substantial gap in interventions aimed at reducing early mortality. Worldwide, the elderly population remains the main target in PC prevention and treatment; however, the low SDI countries should also boost their management of youths at high risk for PC.

In summary, as a consequence of rapid economic and dietary structure development in developing countries, PC has gradually become a common cancer worldwide, as well as there has been a higher increase of EAPC of PC-related deaths in developing countries. The main cause of this change is the lack of control of PC risk factors, such as FPG, BMI, and smoking in lower SDI areas. Furthermore, developing regions should also pay attention to the rapidly increasing rate of premature deaths. To reduce the number of PC-related deaths and burden, it is the most important to intervene in the early stages of PC in order to significantly decrease the risk factors. Meanwhile, compared with the developing regions, developed countries should maintain continuous efforts in reducing PC-related risks in the future. The renewal of PC burden analysis in this paper at multiple levels in GBD database is very beneficial for each country to determine individual policies to control the increasing trend of this disease.

Conflict of interest

The authors declare that they have no competing interests.

Funding

We first appreciate the great work by the Global Burden of Disease Study 2019 collaborators. This work was supported by grants from the Research Project established by Chinese Pharmaceutical Association Hospital Pharmacy department (NO. CPA-Z05-ZC-2022-002).

Authors’ contributions

X.T. designed the study and wrote the manuscript. X.T., H.X., and D.D. collected and analyzed the data. L.L. performed the statistical analysis. X.T. and H.X. edited the manuscript and provided valuable suggestions for study design and data analysis. All authors have approved the final version of this paper.

Consent for publication

Not applicable

Ethics approval and consent to participate

Not applicable

Availability of data and material

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Appendix

Figure A1.

(a) PC-related DALYs, YLL and YLD at global level in 1990–2019; (b) PC-related incidence and prevalence at global level in 1990–2019.

Abbreviations

PC	pancreatic cancer
FPG	fasting plasma glucose
BMI	body mass index
GBD	Global Burden of Diseases
IRFS	Injuries and Risk Factors Study
ASDR	age-standardized death rate
SDI	sociodemographic index
GHDx	Global Health Data Exchange
DALYs	disability-adjusted life years
YLLs	years of life lost
YLDs	years of life lived with disability