Abstract
BACKGROUND: Pancreatic cancer and pancreatitis cause substantial mortality and morbidity, yet their joint global burden, epidemiology and determinants are rarely assessed together. We quantified their joint incidence burden, identified co-occurrence patterns, and examined shared risk exposures across countries. METHODS: Incidence rates for both diseases among adults aged ≥ 25 years across 204 countries and territories were obtained from the Global Burden of Disease (GBD) 2021 study. Temporal trends were assessed through estimated annual percent changes (EAPC). Country-level co-occurrence clusters were identified using Gaussian mixture modeling. Random forest models with Shapley additive explanations were used to investigate associated risk exposures. Non-seasonal time-series models were used to forecast incidence to 2040. RESULTS: High-income countries predominantly clustered as dual-high for both conditions and showed modest to rapidly increasing incidence, whereas most sub-Saharan African countries were dual-low and largely stable. Many middle-SDI (Sociodemographic index) settings remained low but increased moderately over time. Smoking, alcohol use, high body-mass index, and diets high in red and processed meat were shared risk factors, with higher exposure levels in high-SDI regions. Projections indicate that pancreatic cancer incidence will continue to rise globally through 2040, driven mainly by high- and high-middle SDI regions, while pancreatitis incidence will remain comparatively stable. CONCLUSION: Co-occurrence of pancreatic cancer and pancreatitis follows a strong sociodemographic gradient that parallels the distribution of modifiable risk exposures. Integrated strategies combining targeted surveillance with lifestyle and metabolic risk reduction are needed to mitigate the growing joint burden of pancreatic diseases.