The effect of HFPG on mortality and disease burden of pancreatic cancer in China was comprehensively analyzed in this study. To the best of our knowledge, this is the first study to address this issue, which is not only important for the diagnosis and treatment of pancreatic cancer but also has immense applied value and significance for the epidemiology of pancreatic cancer. The number of pancreatic cancer deaths and mortality rates due to HFPG in China have been on the rise from 1990 to 2019. The mortality rate has stabilized based on the results of mortality prediction for the next 20 years. However, owing to the characteristics of pancreatic cancer such as high mortality rate and poor prognosis, the specific pathological mechanism of HFPG-induced deaths from pancreatic cancer as well as scientific research should be explored further. Such studies are expected to contribute to the treatment and prevention of pancreatic cancer.
Pancreatic cancer is a highly malignant gastrointestinal cancer with late detection, high mortality, poor prognosis, and lack of effective treatment[14]. The global burden of the disease has been increasing over the past few decades, with a particularly significant surge in Asia. Despite this increase, research on pancreatic cancer is focused on a few developed Asian countries, such as China, Japan, and South Korea4. Data from the GBD 2019 study were used to comprehensively analyze the impact of pancreatic cancer in China. Data on the association between HFPG and the number of deaths and mortality rate from pancreatic cancer were obtained from the GBD 2019 study.
Abnormal glucose metabolism exacerbates the risk of death. The global population has grown by 44.67% over the past 30 years, and cancer mortality due to HFPG has increased by 179.37%, which is approximately four times the population growth rate. This is a serious global public health issue that warrants our immediate attention. Previous studies have reported that HFPG is associated with various malignancies, such as colorectal, breast, and pancreatic cancers, affecting disease progression and increasing the mortality rate. Thus, HFPG may aggravate the disease burden of pancreatic cancer13,14. Sociodemographic indices were positively associated with pancreatic cancer burden. Smoking, HFPG, and high body mass index accounted for 19.2%, 9.3%, and 9.3%, respectively, of attributable disability-adjusted years in 2019[15]. HFPG levels, especially in patients with type 2 diabetes mellitus, are an important risk determinant for pancreatic cancer[16–17]. From 1990 to 2019, its share of total mortality increased in both sexes. Although the age-standardized prevalence of diabetes in adults in Europe has remained constant and not increased significantly, the number of adults with diabetes has escalated owing to population growth and aging [5]. Therefore, if adequate intervention is lacking, poor glycemic control will have a huge impact on pancreatic cancer-related deaths. One promising strategy is to pay particularly close attention to new-onset diabetes, which has been shown to be associated with a much higher risk of pancreatic cancer [6], to enable early medical interventions when necessary.
The quality and safety of pancreatic cancer surgery have improved in recent years because of the increasing use of minimally invasive techniques and surgical adjuvants. Moreover, systemic chemotherapy is gradually improving the survival. It is now increasingly used as neoadjuvant therapy, usually accompanied by radiotherapy. In conclusion, pancreatic cancer remains a disease with poor long-term survival. To date, the prognosis appears to be poor. Recent advancements have enhanced the outcomes and transformed the approach of the last decade, but the benefits of new therapies have been modest. Future treatments for pancreatic cancer should explore more scientific and novel approaches, which require concerted efforts.
There are certain limitations in this study. First, the GBD 2019 study collected data from various sources. Hence, the quality of the original data, which was based on individual registries, largely influenced the accuracy and robustness of the estimates in the database. Second, the impact of risk factors was not considered in the predictions. Other identified risk factors (e.g., chronic pancreatitis and family history of pancreatic cancer) and potential risk factors (e.g., heavy alcohol consumption, red meat intake, gastrointestinal motile yeast intake, Helicobacter pylori infection, and hepatitis B/hepatitis C virus infection)[18–19] were not estimated owing to the limited information in the GBD 2019 database.
In conclusion, our study found that the number of deaths from pancreatic cancer and the mortality rate attributable to HFPG have been on the rise in China over the past 30 years. It is expected that the number of deaths and the mortality rate will continue to grow slowly over the next two decades as the diagnosis and treatment strategies have evolved. These findings suggest that the growing burden of pancreatic cancer faced over the past three decades needs to be addressed in the future. Lifestyle interventions, early detection, and improved patient management may aid health systems to be better prepared for overcoming this public health threat.