Asia’s accelerating burden of early-onset pancreatic cancer: a 32-year global comparative analysis using GBD 2021

Background: This study quantified age-, sex-, and geography-stratified trends in fatal and nonfatal burdens of early-onset pancreatic cancer (EOPC) across global populations, sociodemographic index (SDI) regions, and high-burden Asian countries from 1990-2021. Methods: We analyzed Global Burden of Disease (GBD) 2021 data to quantify trends in EOPC burden using three epidemiological measures: mortality, incidence, and disability-adjusted life years (DALYs). Joinpoint regression subsequently calculated average annual percentage changes (AAPCs) in EOPC burden trajectories. Results: Globally in 2021, EOPC accounted for 31,531 new cases and 26,996 deaths. Analyses revealed a concerning upward trajectory in EOPC burden, with persistently high disease burden observed in high-SDI regions. Asia bore the highest global EOPC burden (2021), predominantly driven by East Asia where developing nations—particularly China and India—disproportionately contributed. Crucially, while global pancreatic cancer data identified high fasting plasma glucose (FPG) as the primary risk factor (surpassing smoking), this metabolic shift was not observed in EOPC. Moreover, EOPC risk escalates with advancing age and disproportionately affects older males, corresponding to significantly elevated disease burden in this demographic. Conclusions: Over recent decades, the burden of EOPC has escalated steadily, revealing striking demographic gradients, geographic disparities, and evolving risk profiles. These findings underscore an urgent imperative for precision public health interventions targeting high-risk populations. Timely implementation is critical to mitigate EOPC’s disproportionate burden across Asia and developing nations, ultimately reversing its global trajectory.