Global and regional disparities in the burden of disease and risk factors between pancreatitis and pancreatic cancer: a systematic analysis for the global burden of disease study.

Globally, the estimated number of new pancreatitis cases in 2019 reached 2,814,972 (95% UI 2,414,361 to 3,293,592), corresponding to an incidence rate of 36.38 / 100,000 persons (95% UI: 31.20 to 42.57). The global age-standardized incidence rate (ASIR) was 34.8 per 100,000 (95% UI:29.8–40.7). Globally, ASIRs decreased in majority of the GBD region exhibits a decreasing trend, with China the largest decreasing rate, while South Asia, Eastern Europe, and Western Sub-Saharan Africa demonstrated increasing trends. (Table  2 ; Fig.  1 A) Fig. 1 Region specific age-standardized ( A ) Incidence, ( B ) Prevalence, ( C ) Death, ( D ) DALY rates and EAPC by sex from 1990–2019 Region specific age-standardized ( A ) Incidence, ( B ) Prevalence, ( C ) Death, ( D ) DALY rates and EAPC by sex from 1990–2019 Regionally, the highest ASIRs were observed in Eastern Europe, high-income North America, and Central Europe, whereas the lowest ASIR occurred in Tropical Latin America, central sub-Saharan Africa, and Eastern Sub-Saharan Africa. The Russian Federation had the highest national ASIR, while Paraguay, Brazil, and several Sub-Saharan African countries reported the lowest values (Fig.  1 A). Globally, pancreatitis incidence in 2019 was concentrated in individuals aged 25 to 49 years and 50 to 74 years, with the highest case numbers reported in South Asia. Pronounced sex differences in ASIR were observed in Eastern Europe, Central Europe, South Asia, and high-income Asia Pacific regions, with consistently higher rates in men. A higher proportion of cases in older adults (> 75 years) was also observed is Western Europe, High-income North America, Australasia and high-income Asia Pacific, where individuals aged ≥ 75 years represented a substantial proportion of incident cases. (Fig.  2 A). Fig. 2 Region specific ( A ) Incidence, ( B ) Prevalence, ( C ) Death, ( D ) DALY rates and proportions of pancreatitis by age groups from 1990–2019 Region specific ( A ) Incidence, ( B ) Prevalence, ( C ) Death, ( D ) DALY rates and proportions of pancreatitis by age groups from 1990–2019 China’s ASIR (26.8 per 100,000; 95% UI: 22.8–31.3) was below the global average (Fig.  1 A). Incident cases increased from 380,018 (95% UI 308,669 to 462,767) in 1990 to 493,765 (95%UI 416,705 to 578,675) in 2019, with males accounting for more than half (280,913, 95%UI 235,648 to 330,689). In addition, the incidence rate of men (38.8, 95% UI 32.5 to 45.6) was significantly higher than that of women (30.5, 95%UI 25.6 to 35.9). (Table  1 ) Incidence rates were consistently higher in men than in women throughout the study period. Table 1 The incidence, prevalence, DALYs cases and rate of pancreatitis of different gender and age groups in China in 2019, and its Temporal trends from 1990 to 2019 Characteristics Incidence Prevalence DALYs Counts (95% UI) Rate per 100,000 population (95% UI) 1990–2019 EAPC (95% CI) Counts (95% UI) Rate per 100,000 population (95% UI) 1990 -2019EAPC (95% CI) Counts (95% UI) Rate per 100,000 population (95% UI) 1990-2019EAPC (95% CI) All 493,765(416,705 to 578,675) 34.7(29.3 to 40.7) 0.14(-0.18 to 0.45) 294,837(255,299 to 337,195) 20.7(17.9 to 23.7) 1.39(1.27 to 1.51) 301,310(237,110 to 363,324) 21.2(16.7 to 25.5) -0.83(-0.88 to -0.78) Male 280,913(235,648 to 330,689) 38.8(32.5 to 45.6) 0.06(-0.24 to 0.37) 167,250(144,878 to 190,879) 23.1(20.0 to 26.3) 1.66(1.57 to 1.74) 191,988(142,573 to 243,679) 26.5(19.7 to 33.6) -0.23(-0.34 to -0.13)  < 20 years 6,739(4,272 to 10,097) 4.2(2.6 to 6.2) -1.79(-2.22 to -1.37) 2,669(1705 to 3,829) 1.7(1.1 to 2.4) -1.46(-1.89 to -1.03) 2,500(1,924 to 3,151) 1.5(1.2 to 2.0) -3.26(-3.38 to -3.14)  20 to 24 4,804(2,644 to 7,718) 11.2(6.2 to 18.0) -1.57(-2.00 to -1.14) 1,567(1,086 to 2,094) 3.7(2.5 to 4.9) -1.77(-2.31 to -1.23) 3,171(2,276 to 4,156) 7.4(5.3 to 9.7) -3.10(-3.38 to -2.82)  25 to 29 12,008(7,674 to 18,209) 21.3(13.6 to 32.3) -1.32(-1.64 to -1.01) 3,212(2,322 to 4,347) 5.7(4.1 to 7.7) -1.60(-2.00 to -1.18) 7,954(5,769 to 10,187) 14.1(10.2 to 18.1) -2.00(-2.21 to -1.78)  30 to 34 24,761(15,281 to 37,187) 37.9(23.4 to 57.0) -1.08(-1.34 to -0.83) 6,320(4,701 to 8,229) 9.7(7.2 to 12.6) -1.03(-1.29 to -0.77) 13,935(10,400 to 17,683) 21.3(15.9 to 27.1) -1.78(-1.96 to -1.60)  35 to 39 25,649(16,515 to 37,536) 49.9(32.1 to 73.0) -1.10(-1.39 to -0.81) 7,381(5,572 to 9,294) 14.4(10.8 to 18.1) -0.68(-0.86 to -0.51) 13,563(9,822 to 17,509) 26.4(19.1 to 34.1) -2.09(-2.29 to -1.89)  40 to 44 27,971(18,019 to 41,141) 53.9(34.7 to 79.3) -1.22(-1.56 to -0.87) 11,180(8,731 to 14,197) 21.6(16.8 to 27.4) -0.28(-0.38 to -0.17) 16,236(11,131 to 22,036) 31.3(21.5 to 42.5) -2.02(-2.17 to -1.87)  45 to 49 33,919(22,212 to 49,907) 54.9(35.9 to 80.7) -1.18(-1.51 to -0.86) 17,068(13,749 to 21,196) 27.6(22.2 to 34.3) -0.20(-0.25 to -0.14) 19,581(13,770 to 26,372) 31.7(22.3 to 42.6) -1.80(-2.01 to -1.59)  50 to 54 33,035(21,477 to 47,727) 52.6(34.2 to 75.9) -1.18(-1.49 to -0.87) 22,490(18,015 to 27,647) 35.8(28.7 to 44.0) 0.12(0.07 to 0.17) 21,497(14,710 to 28,426) 34.2(23.4 to 45.2) -2.06(-2.16 to -1.96)  55 to 59 23,379(15,123 to 33,770) 49.1(31.7 to 70.9) -1.33(-1.68 to -0.98) 19,843(15,543 to 24,977) 41.7(32.6 to 52.4) 0.11(0.00 to 0.22) 17,774(12,082 to 23,412) 37.3(25.4 to 49.1) -1.69(-1.75 to -1.63)  60 to 64 20,216(13,030 to 30,618) 51.2(33.0 to 77.6) -1.40(-1.77 to -1.02) 20,216(15,624 to 25,133) 51.2(39.6 to 63.7) 0.35(0.23 to 0.46) 17,402(12,233 to 23,148) 44.1(31.0 to 58.7) -1.29(-1.44 to -1.14)  65 to 69 21,335(13,613 to 31,299) 61.8(39.4 to 90.6) -1.39(-1.78 to -1.01) 20,093(15,355 to 25,671) 58.2(44.4 to 74.3) 0.19(0.05 to 0.32) 17,819(12,703 to 23,344) 51.6(36.8 to 67.6) -1.19(-1.33 to -1.05)  70 to 74 17,777(11,232 to 25,520) 76.2(48.1 to 109.4) -1.35(-1.73 to -0.97) 16,092(12,864 to 19,909) 69.0(55.1 to 85.3) 0.44(0.36 to 0.53) 15,894(11,406 to 20,311) 68.1(48.9 to 87.1) -1.19(-1.32 to -1.07)  75 to 79 13,821(9,113 to 19,322) 97.8(64.5 to 136.7) -1.29(-1.67 to -0.91) 10,194(8,138 to 12,653) 72.1(57.6 to 89.5) 0.24(0.18 to 0.30) 11,807(8,489 to 15,289) 83.5(60 to 108.2) -1.01(-1.10 to -0.92)  80 plus 15,500(10,702 to 21,650) 131.6(90.9 to 183.9) -1.20(-1.55 to -0.85) 8,924(7,389 to 10,874) 75.8(62.8 to 92.3) 1.23(1.13 to 1.34) 12,855(9,873 to 15,956) 109.2(83.8 to 135.5) -0.62(-0.73 to -0.50) Female 212,852(178,910 to 250,742) 30.5(25.6 to 35.9) 0.26(-0.07 to 0.60) 127,587(109,827 to 146,695) 18.3(15.7 to 21.0) 1.06(0.90 to 1.22) 109,322(76,079 to 139,529) 15.7(10.9 to 20.0) -1.72(-1.83 to -1.61)  < 20 years 5,562(3,525 to 8,333) 4.0(2.5 to 6.0) -1.88(-2.27 to -1.49) 2,339(1,525 to 3,344) 1.7(1.1 to 2.4) -1.95(-2.33 to -1.58) 1,980(1,395 to 2,442) 1.4(1.0 to 1.8) -4.37(-4.56 to -4.19)  20 to 24 3,173(1,715 to 5,030) 8.1(4.4 to 12.9) -1.59(-2.00 to -1.19) 1,297(900 to 1,742) 3.3(2.3 to 4.5) -2.25(-2.78 to -1.71) 1,790(1,179 to 2,364) 4.6(3.0 to 6.0) -4.10(-4.55 to -3.64)  25 to 29 6,135(3,866 to 9,522) 11.3(7.1 to 17.5) -1.65(-1.99 to -1.31) 2,277(1,605 to 3,145) 4.2(3.0 to 5.8) -2.31(-2.77 to -1.85) 2,947(1,900 to 3,987) 5.4(3.5 to 7.3) -4.52(-5.20 to -3.82)  30 to 34 10,119(5,956 to 15,409) 15.9(9.3 to 24.2) -1.62(-1.94 to -1.29) 3,628(2,597 to 4,793) 5.7(4.1 to 7.5) -2.03(-2.41 to -1.65) 4,900(3,181 to 6,586) 7.7(5.0 to 10.3) -4.78(-5.42 to -4.13)  35 to 39 10,032(6,266 to 15,111) 20.3(12.7 to 30.5) -1.55(-1.89 to -1.21) 3,648(2,625 to 4,811) 7.4(5.3 to 9.7) -1.82(-2.13 to -1.51) 4,498(2,824 to 6,080) 9.1(5.7 to 12.3) -4.06(-4.21 to -3.90)  40 to 44 12,672(7,807 to 18,789) 25.5(15.7 to 37.8) -1.42(-1.75 to -1.09) 5,521(4,100 to 7,326) 11.1(8.2 to 14.7) -1.35(-1.57 to -1.13) 5,862(3,837 to 7,911) 11.8(7.7 to 15.9) -3.88(-3.98 to -3.79)  45 to 49 18,912(12,252 to 28,241) 31.8(20.6 to 47.4) -1.23(-1.49 to -0.96) 9,310(7,178 to 12,051) 15.6(12.1 to 20.2) -1.07(-1.21 to -0.94) 7,663(4,916 to 10,411) 12.9(8.3 to 17.5) -3.81(-4.09 to -3.53)  50 to 54 23,544(15,007 to 34,519) 37.8(24.1 to 55.4) -1.15(-1.38 to -0.93) 14,376(10,959 to 18,164) 23.1(17.6 to 29.2) -0.67(-0.71 to -0.62) 9,701(6,088 to 12,950) 15.6(9.8 to 20.8) -3.72(-3.91 to -3.53)  55 to 59 20,323(13,010 to 29,980) 43.1(27.6 to 63.5) -1.24(-1.47 to -1.01) 14,455(10,930 to 18,766) 30.6(23.2 to 39.8) -0.60(-0.65 to -0.54) 10,490(6,718 to 13,995) 22.2(14.2 to 29.7) -3.34(-3.64 to -3.05)  60 to 64 20,280(12,973 to 30,880) 51.9(33.2 to 79.0) -1.31(-1.57 to -1.05) 16,063(12,194 to 20,377) 41.1(31.2 to 52.1) -0.37(-0.45 to -0.28) 11,213(7,327 to 14,846) 28.7(18.7 to 38.0) -2.71(-2.86 to -2.57)  65 to 69 23,757(14,979 to 35,165) 66.3(41.8 to 98.1) -1.35(-1.64 to -1.06) 17,870(13,647 to 22,978) 49.9(38.1 to 64.1) -0.48(-0.60 to -0.36) 13,367(8,917 to 17,361) 37.3(24.9 to 48.4) -2.67(-2.81 to -2.52)  70 to 74 20,219(12,621 to 29,505) 82.4(51.5 to 120.3) -1.34(-1.64 to -1.04) 14,870(11,952 to 18,311) 60.6(48.7 to 74.7) -0.16(-0.26 to -0.05) 12,183(8,122 to 15,737) 49.7(33.1 to 64.2) -2.56(-2.67 to -2.46)  75 to 79 16,312(10,549 to 22,916) 103.8(67.1 to 145.9) -1.26(-1.55 to -0.96) 10,155(8,248 to 12,456) 64.6(52.5 to 79.3) -0.18(-0.28 to -0.08) 9,204(6,218 to 11,972) 58.6(39.6 to 76.2) -2.30(-2.44 to -2.16)  80 plus 21,813(15,196 to 30,345) 118(82.2 to 164.1) -1.35(-1.65 to -1.06) 11,778(9,805 to 1,4150) 63.7(53.0 to 76.5) 0.66(0.54 to 0.77) 13,525(9,685 to 17,208) 73.2(52.4 to 93.1) -1.66(-1.77 to -1.55) The incidence, prevalence, DALYs cases and rate of pancreatitis of different gender and age groups in China in 2019, and its Temporal trends from 1990 to 2019 The degree of change in incidence rate in China is higher in women (EAPC=-1.40, 95%UI -1.70 to -1.09) than in men (EAPC= -1.27, 95%UI -1.62 to − 0.93) during 1990–2019. (Table  2 ) The incidence rate declined most markedly among individuals younger than 20 years. (Table  1 ) In 2019, Chinese pancreatitis cases revealed an approximately normal distribution of the incident cases, peaking at 40 to 54 years in men and 50 to 69 years in women. Men had higher incidence than woman before age 60 to 64 years, whereas women exceeded men thereafter. (Fig.  3 A) Fig. 3 Pancreatitis ( A ) Incidence, ( B ) Prevalence, ( C ) Death, ( D ) DALYs, ( E ) YLDs, ( F ) YLL rates by age groups and sex Pancreatitis ( A ) Incidence, ( B ) Prevalence, ( C ) Death, ( D ) DALYs, ( E ) YLDs, ( F ) YLL rates by age groups and sex In 2019, the global average ASIR of pancreatic cancer was 6.4 per 100,000 persons across all age groups. The lowest incidence rates were reported in Sub-Sharan Africa and South Asian regions, while the highest ASIRs were reported in North America, United Arab Emirates, South America, and Southern Europe, with Greenland, Monaco, and United Arab Emirates. Sub-Saharan African countries and South Asian countries showed low incidence rates throughout the study period while high-income regions and certain European areas displayed much higher incidence rates. The geographic distribution of the disease closely matched the patterns which showed both prevalence and mortality rates within the area. Pancreatic cancer incidence increased steadily with age, peaking around 80 years. By analyzing the incidence rate of pancreatic cancer in various age groups, we found that the trend from 1990 to 2019 years was similar in the age groups of < 20, 20 to 24, and 25-to-29-year groups, had the lowest incidence, and relatively stable incidence rates, while incidence increased most prominently among individuals aged 35–49 years. (Fig.S2) The sex-specific incidence was consistently higher in males (7.2 per 100 000 person-years) than in females (5.6 per 100 000 person-years). (Fig.  6 A) In China, the incident cases of pancreatic cancer were the highest in people within the age range of 50–69 years, consistent with patterns observed in Western Europe, High-income North America, High-income Asia Pacific, and South Asia. (Fig.  5 A). The global prevalence of pancreatitis increased from 1,727,789 (95%UI 1,452,132 to 2,059,695) in 1990 to 2,405,756 (95% UI: 2,156,399 to 2,635,780) in 2019, with the prevalence rate rising to 29.3 per 100,000 (95%UI 26.3 to 32.0) (Table  2 ). The regional distribution of age-standardized prevalence rate differed from regional distribution of ASIR (Fig.  1 B). Unlike the incidence, pancreatitis has a rising profile with increasing SDI quintiles in both the number and age-standardized prevalence rate, and the age-standardized prevalence rate shows an increasing trend from 1990 to 2019 in addition to the middle-high SDI quintiles. The three regions with the highest age-standardized prevalence rate (ASPRs) were Eastern Europe, high income North America, and Central Europe, with ASPRs were 15–16 times the lowest, and China is sixth from the bottom (Table  2 ). Sex-related differences in ASPRs were observed in most regions, particularly Eastern Europe, Central Europe, High - income Asia Pacific, and Central Asia. The age-standardized prevalence rate of pancreatitis shows an increase in most regions from 1990 to 2019, most pronounced in Eastern Europe, South Africa and North Africa and Middle East, whereas China showed largest decrease, mainly driven by women (Fig.  1 B). In 2019, the regions with the greatest absolute number of prevalent cases were Eastern Europe, Southern Africa, Western Europe, high-income North America, and China. Across these regions, cases were mainly clustered in the 20–49 year and 50–74-year age groups. In contrast to incidence patterns, the 50–74-year group accounted for a larger share of prevalent cases, including in China (Fig.  2 B). In China, the number of prevalent cases rose from 164,822 (95%UI 143,291 to 185,609) in 1990 to 294,837 (95% UI 255,299 to 337,195) in 2019, with prevalence rate increasing from 13.9 (95% UI: 12.1 to 15.7) to 20.7 (95% UI 17.9 to 23.7) (EAPC = 1.39, 95%UI 1.27 to 1.51) (Table  1 ). As with incidence, prevalence rates and cases numbers were higher in men (23.1, 95% UI: 20.0 to 26.3; 167, 250 cases, 95% UI: 144,878 to 190,879) than in women (18.3, 95% UI: 15.7 to 21.0; 127,587 cases, 95% UI:109,827 to 146,695). Correspondingly, female ASPRs demonstrated a marked downward trend (EAPC = − 0.73, 95% UI -0.81 to − 0.65), whereas male ASPRs remained largely stable (EAPC= -0.04, 95%UI: -0.09 to 0.01). Age-stratified analyses revealed that prevalence rates increased steadily with age, remaining stable across most age groups but rising significantly among individuals ≥ 80 years (EAPC = 0.89, 95% UI: 0.78–1.00) (Fig. S1). Sex-stratified analysis further showed an upward trend after age 50 to 54 in men, whereas this increase was only evident after age 80 in women (Table  1 ). In 2019, prevalent cases in China demonstrated an approximately normal distribution across age groups, with peaks in men at 50 to 69 years and in women at 55 to 74 years. Men had a higher case number than woman up to ages 75 to 79, after which women predominated. The prevalence rate increased gradually with age, peaking at ages 80 to 84 years followed by a decreasing trend, and surprisingly, the prevalence rate was higher in men than in women in all age groups (Table  1 ; Fig.  3 B). The global age-standardized prevalence rate (ASPR) of pancreatic cancer was 5.1 per 100,000 persons, across sexes and all age groups. Regional ASPR distributions differed from ASIR patterns. The prevalence of pancreatic cancer varies across regions. Sub-Sharan Africa, South Asia, and South East Asian countries had low prevalence rate. (Fig.  4 B) The lowest ASPRs were reported in Ethiopia (1.1, 95% UI:0.7 to 1.5), Somalia 1.2 (95% UI: 0.6 to 1.9), Papua New Guinea (1.3, 95% UI: 0.6 to 1.9), and Central African Republic (1.5, 95% UI: 1.0 to 2.1). In contrast, the highest ASPRs were reported in Monaco (15.5, 95% UI: 12.1 to 18.9), Greenland (14.7, 95% UI: 11.9 to 17.4), UAE (13.1, 95% UI: 6.9 to 19.6), Germany (12.9, 95% UI: 9.9 to 16.7), Canada (10.8, 95% UI: 8.4 to 13.7), and USA (9.2, 95% UI: 7.9 to 10.6). Consistent with incidence patterns, most prevalent cases occurred in the 50-to-69-year age group, while relatively few cases were observed among individuals 85 years and above. (Fig.  5 B) ASPRs were higher in men (5.7 per 100,000) than in women (4.5 per 100 000). From 1990 to 2019, prevalence increased particularly among individuals aged 35–49 years. (Fig. S2) Prevalence rose with age, peaking before declining after 80 years, mirroring incidence patterns. Across all age groups, men consistently exhibited higher prevalence rate than women. (Fig.  6 B) Fig. 4 Region specific age-standardized ( A ) Incidence, ( B ) Prevalence, ( C ) Death, ( D ) DALYs rate and EAPC of pancreatic cancer by sex from 1990–2019 Region specific age-standardized ( A ) Incidence, ( B ) Prevalence, ( C ) Death, ( D ) DALYs rate and EAPC of pancreatic cancer by sex from 1990–2019 Fig. 5 Region specific ( A ) Incidence, ( B ) Prevalence, ( C ) Death, ( D ) DALYs rate and proportions of pancreatic cancer by age groups from 1990–2019 Region specific ( A ) Incidence, ( B ) Prevalence, ( C ) Death, ( D ) DALYs rate and proportions of pancreatic cancer by age groups from 1990–2019 Fig. 6 Age and sex specific ( A ) Incidence, ( B ) Prevalence, ( C ) Death and ( D ) DALYs cases and rates of pancreatic cancer from 1990 - 2019 Age and sex specific ( A ) Incidence, ( B ) Prevalence, ( C ) Death and ( D ) DALYs cases and rates of pancreatic cancer from 1990 - 2019 The number of global DALYs for pancreatitis has risen to 3,641,106 (95%UI 3,282,953 to 4,026,948) in 2019, and the rate of DALYs has risen to 44.4 (95%UI 40.1 to 49.1) (Table  2 ). Globally, males were higher than females both in incidence, prevalence and DALYs, as was also the case in China. However, the age-standardized rates in all genders showed a decreasing trend, and the same was true in China except for the male age-standardized prevalence rate (-0.04, 95%UI -0.09 to 0.01). Interestingly, age-standardized DALYs rates from 1990 to 2019 across all SDI quintiles showed a decline. (Table  2 ) Table 2 The incidence, prevalence, dalys cases and age-standardized rate of pancreatitis in 2019, and its Temporal trends from 1990 to 2019 Characteristics Incidence Prevalence DALYs Counts (95% UI) ASR per 100,000 population (95% UI) 1990-2019EAPC (95% CI) Counts (95% UI) ASR per 100,000 population (95% UI) 1990-2019EAPC (95% CI) Counts (95% UI) ASR per 100,000 population (95% UI) 1990–2019 EAPC (95% CI) Global 2,814,972(2,414,361 to 3,293,592) 34.8(29.8 to 40.7) -0.34(-0.41 to -0.27) 2,405,756(2,156,399 to 2,635,780) 29.3(26.3 to 32.0) -0.08(-0.10 to -0.05) 3,641,106(3,282,953 to 4,026,948) 44.4(40.1 to 49.1) -0.74(-0.83 to -0.64) Male 1,541,017(1,307,264 to 1,814,454) 38.8(33.1 to 45.5) -0.22(-0.29 to -0.16) 1,371,524(1,231,567 to 1,500,462) 34.2(30.8 to 37.4) -0.03(-0.04 to -0.02) 2,502,438(2,224,846 to 2,842,384) 62.0(55.2 to 70.4) -0.60(-0.70 to -0.50) Female 1,273,955(1,098,305 to 1,478,594) 30.6(26.4 to 35.6) -0.45(-0.52 to -0.39) 1,034,232(924,955 to 1,142,633) 24.4(21.9 to 26.9) -0.11(-0.17 to -0.05) 1,138,668(969,571 to 1,334,423) 27.0(22.9 to 31.5) -1.00(-1.08 to -0.91) China 493,765(416,705 to 578,675) 26.8(22.8 to 31.3) -1.35(-1.67 to -1.02) 294,837(255,299 to 337,195) 15.1(13.2 to 17.1) -0.37(-0.43 to -0.31) 301,310(237,110 to 363,324) 16.7(13.0 to 19.6) -2.32(-2.37 to -2.28) Male 280,913(235,648 to 330689) 31.1(26.3 to 36.5) -1.27(-1.62 to -0.93) 167,250(144,878 to 190,879) 17.3(15.2 to 19.5) -0.04(-0.09 to 0.01) 191,988(142,573 to 243,679) 21.0(15.7 to 26.5) -1.65(-1.73 to -1.56) Female 212,852(178,910 to 250,742) 22.4(19.1 to 26.2) -1.40(-1.70 to -1.09) 127,587(109,827 to 146,695) 12.8(11.1 to 14.6) -0.73(-0.81 to -0.65) 109,322(76,079 to 139,529) 11.4(7.9 to 14.5) -3.26(-3.35 to -3.17) Social- demographic index  Low 224,225(183,907 to 270,952) 27.7(23.4 to 32.9) 0.14(0.08 to 0.19) 127,830(114,857 to 140,947) 17.8(16.1 to 19.5) 0.69(0.64 to 0.75) 459,380(367,334 to 583,539) 64.0(50.8 to 81.3) -0.53(-0.57 to -0.49)  Low middle 598,531(497,031 to 720,522) 36.5(30.7 to 43.7) 0.23(0.20 to 0.27) 336,264(300,091 to 369,698) 21.7(19.3 to 23.9) 0.80(0.73 to 0.86) 919,233(751,489 to 1,066,252) 58.0(47.3 to 66.8) -0.51(-0.56 to -0.46)  Middle 735,082(616,165 to 867,455) 28.8(24.4 to 34.2) -0.35(-0.51 to -0.19) 484,079(426,537 to 537,798) 18.8(16.7 to 20.8) 0.18(0.15 to 0.20) 813,217(727,040 to 960,673) 31.6(28.2 to 37.2) -1.11(-1.15 to -1.07)  Middle high 667,223(569,619 to 769,409) 36.7(31.5 to 42.6) -0.63(-0.70 to -0.56) 805,477(720,694 to 886,839) 42.6(38.1 to 46.8) -0.16(-0.20 to -0.12) 1,057,815(962,196 to 1,156,821) 57.1(51.9 to 62.4) -0.58(-0.87 to -0.30)  High 533,633(477,730 to 597,075) 38.1(33.9 to 42.7) -0.38(-0.44 to -0.31) 651,311(591,812 to 707,601) 43.9(39.8 to 47.7) 0.16(0.13 to 0.19) 389,933(360,178 to 429,354) 25.7(23.8 to 28.4) -1.23(-1.30 to -1.15) Region  Andean Latin America 26,446(23,242 to 30,102) 43.5(38.4 to 49.3) -0.29(-0.33 to -0.24) 15,555(14,408 to 16,607) 26.2(24.4 to 28.0) 0.27(0.07 to 0.47) 43,655(34,042 to 57,110) 72.5(56.6 to 96.0) -2.67(-2.82 to -2.52)  Australasia 14,395(12,299 to 16,770) 37.6(31.7 to 44.0) -0.13(-0.16 to -0.11) 11,726(10,488 to 12,979) 28.8(25.8 to 32.1) 0.11(0.07 to 0.14) 7,137(6,313 to 8,100) 16.6(14.7 to 18.8) -1.35(-1.53 to -1.17)  Caribbean 14,155(11,773 to 16,693) 28.4(23.5 to 33.6) -0.03(-0.05 to -0.02) 9,080(8,294 to 9,833) 17.9(16.3 to 19.3) 0.60(0.53 to 0.66) 20,255(16,880 to 24,620) 40.1(33.3 to 48.7) -0.35(-0.44 to -0.25)  Central Asia 29,035(24,077 to 34,326) 32.9(27.7 to 38.5) -0.07(-0.09 to -0.05) 37,582(34,740 to 40,458) 42.7(39.7 to 45.7) 0.87(0.61 to 1.14) 60,311(51,432 to 69,088) 67.4(57.0 to 76.9) -0.95(-1.35 to -0.56)  Central Europe 73,016(64,542 to 82,157) 45.2(40.1 to 50.9) -0.41(-0.45 to -0.36) 114,108(105,788 to 121,745) 67.0(62.1 to 71.5) 0.21(0.19 to 0.23) 140,578(123,451 to 158,896) 84.4(74.0 to 95.6) -1.00(-1.15 to -0.85)  Central Latin America 96,777(83,302 to 112,767) 38.6(33.3 to 44.7) -0.05(-0.08 to -0.02) 62,315(56,220 to 67,872) 25.2(22.8 to 27.4) -0.36(-0.44 to -0.29) 141,733(121,886 to 165,140) 56.5(48.7 to 65.7) -0.67(-0.82 to -0.52)  Central Sub-Saharan Africa 18,256(14,929 to 22,374) 20.8(17.5 to 24.7) -0.03(-0.04 to -0.02) 10,403(9,361 to 11,511) 12.6(11.5 to 13.7) 0.58(0.47 to 0.68) 35,823(21,455 to 62,657) 44.6(26.5 to 80.0) -0.67(-0.80 to -0.54)  East Asia 526,066(444,787 to 615,193) 27.6(23.5 to 32.2) -1.25(-1.56 to -0.95) 311,927(271,304 to 356,253) 15.4(13.5 to 17.4) -0.29(-0.35 to -0.23) 319,973(255,865 to 381,414) 16.5(13.2 to 19.6) -2.26(-2.30 to -2.23)  Eastern Europe 221,945(188,142 to 258,014) 79.6(68.2 to 92.5) 0.38(0.31 to 0.45) 382,652(337,905 to 426,725) 135.4(120.1 to 150.9) 1.32(1.27 to 1.38) 558,129(481,179 to 640,436) 206.7(178.3 to 237.9) 1.92(1.33 to 2.50)  Eastern Sub-Saharan Africa 57,966(46,839 to 71,275) 21.1(17.7 to 25.2) -0.03(-0.05 to -0.01) 27,204(24,065 to 30,678) 10.7(9.6 to 11.8) 0.55(0.47 to 0.62) 103,187(65,328 to 170,639) 43.3(27.1 to 73.7) -0.52(-0.60 to -0.44)  High-income Asia Pacific 78,998(68,905 to 90,261) 31.5(27.3 to 36.5) -0.28(-0.35 to -0.21) 130,280(114,729 to 146,641) 45.8(40.3 to 51.5) 0.11(0.01 to 0.21) 48,064(41,966 to 56,862) 14.7(12.7 to 17.4) -2.49(-2.63 to -2.35)  High-income North America 257,778(236,253 to 284,188) 52.0(47.5 to 56.9) -0.65(-0.82 to -0.48) 289,784(265,546 to 313,611) 55.9(51.4 to 60.2) 0.16(0.04 to 0.28) 145,495(134,413 to 161,035) 28.6(26.4 to 31.6) -0.29(-0.45 to -0.13)  North Africa and Middle East 140,638(117,038 to 168,090) 26.6(22.5 to 31.2) 0.02(0.00 to 0.04) 67,643(59,470 to 76,309) 13.4(11.9 to 14.9) 0.96(0.88 to 1.03) 91,833(74,033 to 111,078) 19.5(15.7 to 23.3) -0.93(-1.01 to -0.85)  Oceania 2,386(1,935 to 2,926) 24.1(20.0 to 28.7) -0.11(-0.11 to -0.10) 878(763 to 1,000) 8.5(7.6 to 9.5) 0.11(0.04 to 0.18) 3,181(2,194 to 4,459) 30.3(21.4 to 42.0) -0.42(-0.44 to -0.39)  South Asia 743,524(611,176 to 901,906) 43.0(35.9 to 51.7) 0.51(0.44 to 0.59) 350,748(308,526 to 387,993) 21.8(19.3 to 24.1) 0.98(0.88 to 1.08) 909,994(707,700 to 1,093,716) 55.3(43.1 to 66.4) -0.74(-0.86 to -0.61)  Southeast Asia 174,246(143,847 to 208,675) 25.3(21.2 to 30.1) -0.10(-0.11 to -0.09) 107,443(95,687 to 118,068) 15.9(14.3 to 17.5) 0.47(0.43 to 0.52) 254,592(204,677 to 376,979) 37.9(30.8 to 54.8) -1.41(-1.47 to -1.34)  Southern Latin America 24,167(20,962 to 27,835) 31.6(27.4 to 36.6) -0.32(-0.36 to -0.29) 20,385(18,968 to 21,756) 25.8(23.9 to 27.6) 0.12(0.04 to 0.21) 40,292(36,540 to 45,859) 51.6(46.8 to 58.8) -1.72(-1.94 to -1.50)  Southern Sub-Saharan Africa 15,207(12,561 to 18,529) 21.7(18.1 to 25.9) -0.10(-0.14 to -0.06) 8,984(7,880 to 10,116) 12.9(11.4 to 14.4) -0.07(-0.23 to 0.1) 21,221(16,850 to 25,384) 30.0(23.8 to 35.7) -0.87(-1.25 to -0.49)  Tropical Latin America 47,509(41,862 to 53,770) 19.4(17.1 to 21.9) -0.12(-0.17 to -0.06) 126,984(112,589 to 141,716) 51.1(45.4 to 56.9) -0.16(-0.21 to -0.11) 175,860(155,755 to 189,220) 70.6(62.5 to 76.0) -0.01(-0.11 to 0.10)  Western Europe 170,344(149,047 to 194,757) 26.3(22.8 to 30.1) -0.05(-0.14 to 0.05) 238,146(215,921 to 259,944) 34.2(30.6 to 37.3) 0.17(0.14 to 0.21) 199,700(183,864 to 224,327) 27.1(25.2 to 30.4) -1.41(-1.47 to -1.35)  Western Sub-Saharan Africa 82,117(68,166 to 98,902) 26.7(22.7 to 31.4) 0.10(0.09 to 0.11) 81,926(73,371 to 91,009) 30.7(27.4 to 33.9) 0.58(0.53 to 0.63) 320,090(226,679 to 458,546) 115.5(82.3 to 165.9) -0.15(-0.22 to -0.08) The incidence, prevalence, dalys cases and age-standardized rate of pancreatitis in 2019, and its Temporal trends from 1990 to 2019 High-income Asia Pacific There is a clear regional distribution of the global burden of disease for pancreatitis in 2019 with South Asia, Eastern Europe, Western Sub-Saharan Africa, and China being the leading sources of DALYs. The number of DALYs observed by age was concentrated at ages 20 to 49 years and 50 to 74 years, with the largest proportion at all ages. However, the proportion of DALYs in individuals older than 75 years was much higher in some regions than others, including the high-incidence Asia Pacific, Western Europe, and Australasia (Fig.  2 D). There was also substantial variation in age-standardized DALYs rates by sex, with nearly all regions exhibiting higher rates in men than in women, particularly in Eastern Europe, Western Sub-Saharan Africa, and Central Europe, compared with China, which had small between sex differences and exhibited very low overall age-standardized DALYs rates. From 1990 to 2019, the EAPC for DALYs in most regions showed a decreasing trend except Eastern Europe, where the opposite trend was observed, with the most pronounced change in females (Fig.  1 D; Table  2 ). According to GBD 2019, the DALYs of pancreatitis in China will drop from (320,705, 95% UI 254,956 to 416,932) in 1990 to (301,310, 95% UI 237,110 to 363,324) in 2019, and DALYs rate decreased from 27.1 (95% UI 21.5 to 35.2) to 21.2 (95% UI 16.7 to 25.5) (EAPC= -0.83, 95% UI -0.88 to -0.78). Compared with males (EAPC= -1.65, 95% UI -1.73 to -1.56), age-standardized DALYs rate of females showed a greater trend in 2019 (EAPC = − 3.26, 95% UI -3.35 to -3.17). (Tables  1 and 2 ; Fig.  1 D). From the composition of DALYs, YLLs is the dominant part, showing a downward trend, while YLDs is the minor component, although showing an upward trend. YLLs decreased in all age groups, but YLDs remained comprehensively stable from 1990 to 2019, except for those over 80 years old, which was consistent with the prevalence rate (Fig.S1). The male’s DALYs is concentrated in the age range of 50 to 54 years, which is younger than that of female (Concentrated between 65 and 69 years); DALY rates increased with age and were consistently higher in males than in females, and the same was true in YLDs and YLLs (Fig.  3 D, E and F). In addition, all age groups showed a decreasing trend in Daly rates for both sexes and overall showed greater changes for younger, female (Table  1 ). Globally, the average DALYs rate (for both sexes and all age groups) was 6.5 per 100 000 person years. The sex specific DALYs rate was higher in men (7.4) than women (5.8) in all age groups. (Fig.  6 D) The lowest DALYs rate (for both sexes) was reported in sub-Saharan Africa such as Ethiopia 1.6 (95% UI 1.1 to 2.3), Somalia 1.7 (95% UI 0.9 to 2.7), Guinea 1.9 (95% UI 1.5 to 2.4) and South Asia countries such as Bangladesh 2.2 (95% UI 1.4 to 3.3), Siri Lanka 3.9 (95% UI 2.2 to 3.9), and Nepal 3.0 (95% UI 1.8 to 4.4). (Fig.  5 D) The highest DALYs rate (for both sexes) was reported in Greenland 19.3 (95% UI 15.7 to 22.8), Monaco 17.8 (95% UI 14.2 to 21.2), United Arab Emirates 17.6 (95% UI 9.4 to 26.2), Uruguay 14.5(95% UI 13.2 to 15.7), Hungary 12 (95% UI 9.9 to 14.4), Palau 12 (95% UI 9.2 to 15) and Argentina 11.9 (95% UI 10.9 to 13). Fig.  4 D. Although there are differences between genders, the death rate from 1990 to 2019 has little change. In all age groups, the mortality rate of pancreatitis was higher in men than women and the death is more concentrated in the high age group. (Fig.  2 C) With respect to deaths from pancreatitis, age-standardized death rate and its changes were overall like DALYs. However, the number of deaths and their proportion differed among age groups, mainly indicated by the greatly increased proportion of deaths in people older than 75 years, and in some regions even more than half, such as Western Europe, High-income Asia Pacific, and Australasia. Mortality cases of pancreatitis in China, was mainly concentrated in people over 50 years of age. (Fig.  2 C) The average-standardized pancreatic cancer mortality rate (for both sexes and all age groups) was 142.3 per 100 000 person-years. Whereas, the average standardized mortality rate of pancreatic cancer was higher in men (165.4) than in women (121.1) per 100 000 person-years in all age groups. The regions with higher mortality rate of pancreatic cancer (for both sexes) include high income North America, UAI, and southern, western, and central Europe. (Fig.  4 C) The number of pancreatic cancer deaths in the age group of 50 to 69 and 75 to 84 years occupies a larger proportion, whereas the number of cases aged 25 to 49 years occupies a smaller proportion. (Fig.  5 C) The highest mortality was recorded in Greenland 425.7 (95% UI 342.4 to 512.3), United Arab Emirates 400.4 (95% UI 208.8 to 608), Monaco 360.2 (95% UI 279.7 to 440.4), Uruguay 304.4 (95% UI 280 to 329.6), Bulgaria 272.6(95% UI 211.6 to 343), Hungary 271.5(95% UI 221.4 to 343), Palau 257.6 (95% UI 198 to 326), and Czechia 253.7(95% UI 203.3 to 309.5). The lowest mortality rate (for both sexes) was reported in sub-Saharan Africa countries such as Ethiopia 34.3 (95% UI 22.9 to 49.8), Somalia 41.2 (95% UI 22.3 to 66.4), Guinea 43.4 (95% UI 29.6 to 61) and South Asian counties such as Bangladesh 47.4 (95% UI 30.2 to 70), Nepal 63.1 (95% UI 37.9 to 92), and Siri Lanka 63.8 (95% UI 47.1 to 85.7). The death rate increased gradually with age while decreasing trend after 80 years in consistent with incidence and prevalence rate. The mortality was higher in men than women. (Fig.  6 C) By analyzing the correlation between age-standardized rates and SDI in 204 countries, a clear correlation was found between ASIR of pancreatitis and SDI. (Fig.  7 A) There was a significant positive correlation between the ASIR, age-standardized YLDs rate of pancreatitis and SDI ( r  = 0.311, p  < 0.001; r  = 0.404, p  < 0.001), suggesting that ASIR and YLDs increased as socio-demographic levels increased. (Fig.  7 A and E) There was a significant inverse correlation between pancreatitis ASMR, age-standardized YLLs rate and SDI, with many higher-than-expected levels in both high and low SDI countries ( r  = − 0.34, p  < 0.001; r  = − 0.34, p  < 0.001) (Fig.  7 B and D). Although the age-standardized rates in China are at a low level globally, the incidence, prevalence, and number of DALYs due to pancreatitis in China are among the top of the world. Fig. 7 Age-standardized ( A ) Incidence, ( B ) Mortality, ( C ) Prevalence, ( D ) YLLs, ( E ) YLDs rates of pancreatitis and their correlations with SDI levels Age-standardized ( A ) Incidence, ( B ) Mortality, ( C ) Prevalence, ( D ) YLLs, ( E ) YLDs rates of pancreatitis and their correlations with SDI levels There was positive correlation between the age-standardized pancreatic cancer incidence and prevalence rate with SDI ( r  = 0.739, p  < 0.001; r  = 0.761, p  < 0.001), suggesting that ASIR and age-standardized prevalence rate increased as socio-demographic levels increased. (Fig.  8 A and B) In addition, there was correlation between the ASMR, and SDI ( r  = 0.686, P  < 0.001) (Fig.  8 C). Countries with highest SDI such as Switzerland (SDI = 92.7), Norway (SDI = 90.6), Monaco (SDI = 90.3), and Germany (SDI = 89.7) had above average ASIR. Conversely, countries with lowest SDI such as Niger (SDI = 17), Chad (SDI = 24.8), and Mali (SDI = 26.3), Burkina Faso (SDI = 26.4) had pancreatic cancer incidence, prevalence, mortality, DALYs rates lower than average. Fig. 8 Age-standardized ( A ) Incidence, ( B ) Prevalence, and ( C ) Mortality rates of pancreatic cancer and their correlations with SDI levels Age-standardized ( A ) Incidence, ( B ) Prevalence, and ( C ) Mortality rates of pancreatic cancer and their correlations with SDI levels We have retrieved data on risk factors (including alcohol consumption, BMI, physical inactivity, obesity, hypertension, diabetes, HDL cholesterol, non-HDL cholesterol, smoking, and total cholesterol) and their attributable fractions of pancreatitis during 1990–2019. The incidence of pancreatitis was significantly correlated with obesity ( r  = 0.317, p-value < 0.001), alcohol use ( r  = 0.496, p-value < 0.001), smoking ( r  = 0.406, p-value < 0.001), BMI (OR = 0.279, p  < 0.001), hypertension (OR = 0.581, p  < 0.001), total cholesterol ( r  = 0.667, p-value < 0.001), HDL cholesterol ( r  = 0.561, p-value < 0.001), and non-HDL cholesterol (OR = 0.503, p  < 0.001). The prevalence of pancreatitis was associated with alcohol ( r  = 0.546, p  < 0.001), BMI (OR = 0.159, p  < 0.001), obesity ( r  = 0.211, p  < 0.001), HDL cholesterol ( r  = 0.632, p  < 0.001), hypertension ( r  = 0.66, p  < 0.001), non-HDL cholesterol (OR = 0.408, p  < 0.001), smoking ( r  = 0.396, p  < 0.001), and total cholesterol ( r  = 0.629, p  < 0.001). Deaths due to pancreatitis was associated with alcohol ( r  = 0.425, p  < 0.001), BMI ( r  = 0.127, p  < 0.001), HDL cholesterol ( r  = 0.407, p  < 0.001), hypertension ( r  = 0.649, p  < 0.001), Non- HDL ( r  = 0.32, p  < 0.001), obesity ( r  = 0.174, p  < 0.001), physical inactivity ( r  = 0.001, p  = 0.994), smoking ( r  = 0.334, p  < 0.001), and total cholesterol ( r  = 0.467, p  < 0.001). Total cholesterol level had high correlation with pancreatitis prevalence ( r  = 0.629, p  < 0.001), incidence ( r  = 0.667, p  < 0.001), deaths ( r  = 0.467, p  < 0.001), DALYs ( r  = 0.290, p  < 0.001), YLDs ( r  = 0.659, p  < 0.001), and YLLs ( r  = 0.267, p  < 0.001). (Fig. S3) According to multivariate analysis, alcohol consumption (OR = 1.24, p  = 0.01), BMI (OR = 2.37, p  = 0.02), high total cholesterol (OR = 1.66, p  < 0.001), and hypertension (OR = 1.26, p  = 0.013) were positively associated with prevalence of pancreatitis. The incidence of pancreatitis was positively associated with alcohol consumption (OR = 1.19, p  < 0.019) and TC (OR = 1.34, p  < 0.001). Only hypertension was significantly associated with deaths (OR = 1.32, p  < 0.001), DALYs (OR = 1.3, p  < 0.001), and YLLs (OR = 1.34, p  < 0.001). Alcohol consumption (OR = 1.23, p  = 0.016), TC (OR = 1.68, p  < 0.001) and hypertension (OR = 1.31, p  < 0.009) were significantly associated with YLDs. (Fig.  9 ) Fig. 9 Multivariate analysis of factors associated with prevalence, incidence, death, DALYs, YLDs, and YLLs of pancreatitis Multivariate analysis of factors associated with prevalence, incidence, death, DALYs, YLDs, and YLLs of pancreatitis According to the GBD 2019 report, we have included the data from 204 countries. Based on this data, the incidence of pancreatic cancer was significantly correlated with obesity ( r  = 0.338, p-value < 0.001), alcohol use ( r  = 0.681, p -value < 0.001), smoking ( r  = 0.447, p-value < 0.001), BMI (OR = 0.258, p  < 0.001), hypertension (OR = 0.583, p  < 0.001), total cholesterol ( r  = 0.753, p value < 0.001), HDL cholesterol ( r  = 0.777, p-value < 0.001), and Non-HDL cholesterol (OR = 0.503, p  < 0.001), physical inactivity (OR = 0.277, p  < 0.001). The prevalence of pancreatic cancer was associated with obesity ( r  = 0.315, p  < 0.001), alcohol use ( r  = 0.669, p  < 0.001), physical inactivity ( r  = 0.274, p  < 0.001), hypertension ( r  = 0.529, p  < 0.001), BMI (OR = 0.234, p  < 0.001), smoking ( r  = 0.415, p  < 0.001), total cholesterol ( r  = 0.731, p  < 0.001), HDL cholesterol ( r  = 0.777, p  < 0.001), and non-HDL cholesterol (OR = 0.479, p  < 0.001). The mortality rate of pancreatic cancer is correlated with obesity ( r  = 0.344, p  < 0.001), alcohol use ( r  = 0.682, p  < 0.001), physical inactivity ( r  = 0.277, p  < 0.001), hypertension ( r  = 0.601, p  < 0.001), BMI ( r  = 0.265, p  < 0.001), smoking ( r  = 0.456, p  < 0.001), total cholesterol ( r  = 0.757, p  < 0.001), HDL cholesterol ( r  = 0.771, p  < 0.001), and non-HDL cholesterol (OR = 0.51, p  < 0.001). Except diabetic mellitus all the other pancreatic cancer risk factors such as alcohol, BMI, HDL cholesterol, hypertension, non-HDL cholesterol, obesity, physical inactivity, smoking, and total cholesterol, were significantly correlated with DALYs, YLDs, and YLLs. (Fig. S4) In multivariate analysis alcohol (OR = 1.58, p  = 0.001), TC (OR = 1.97, p  < 0.001), and hypertension (OR = 1.35, p  = 0.019) were significantly associated with high pancreatic cancer prevalence. Incidence of pancreatic cancer was significantly associated with alcohol consumption (OR = 1.55, p  = 0.002), TC (OR = 2.0, p  < 0.002), and hypertension (OR = 1.31, p  = 0.032). Alcohol consumption, TC, and hypertension were significantly associated with DALYs, YLDs, and YLLs. (Fig.  10 ) Fig. 10 Multivariate analysis of factors associated with prevalence, incidence, death, DALYs, YLDs, and YLLs of pancreatic cancer Multivariate analysis of factors associated with prevalence, incidence, death, DALYs, YLDs, and YLLs of pancreatic cancer The incidence and prevalence of pancreatitis and pancreatic cancer is higher in countries with high SDI; such as in Greenland, Monaco, Germany, Hungary, and United Arab Emirates. In the contrary, the incidence and prevalence were decreased in sub-Saharan African and south Asian countries. The incidence, prevalence, mortality, DALYs, YLDs, and YLLs is higher in men than women both in pancreatitis and pancreatic cancer. Pancreatic cancer prevalence, incidence, mortality, and DALYs are directly correlated with SDI. However, age-standardized mortality rate and age-standardized YLLs has inverse correlation with SDI in pancreatitis. Alcohol consumption, high BMI, HDL cholesterol, hypertension, non-HDL cholesterol, obesity, smoking, physical inactivity and total cholesterol were correlated with pancreatic cancer prevalence, incidence, mortality, DALYs, YLLs, and YLDs but not diabetic mellitus. All the risk factors correlated with pancreatic cancer were similarly correlated with pancreatitis except physical inactivity. In multi-variate analysis, the prevalence of pancreatitis was associated with alcohol consumption, high BMI, total cholesterol, hypertension, diabetic mellitus, and smoking. The incidence of pancreatitis was associated with alcohol and total cholesterol. Only alcohol, total cholesterol, and hypertension were associated with prevalence, incidence, mortality, DALYs, YLLs, and YLDs of pancreatic cancer.

The disease burden data for pancreatic cancer and pancreatitis were derived from an online data source tool, the Global Health Data Exchange (GHDx) query tool ( http://ghdx.healthdata.org/gbd-results-tool ), which were collected and analyzed by a group of researchers from various countries. Since 1990, the early death and disability of 369 diseases and injuries in 204 countries have been recorded by age and gender, so that they can be compared among different time, age groups and populations. Pancreatic cancer and pancreatitis incidence, mortality, prevalence, DALY, and respective age-standardized rate (ASR) data from 1990 to 2019 were obtained from GBD study 2019. The sociodemographic Index (SDI) is a composite indicator of background social and economic conditions that influence health outcomes in each location. In short, it is the geometric mean of 0 to 1 indices of total fertility rate (TFR) for those younger than 25 years old (TFU25), mean education for those 15 years old and older (EDU15+), and lagdistributed income (LDI) per capita. For GBD 2019, after calculating SDI, values were multiplied by 100 for a scale of 0 to 100. DALYs were calculated as the sum of years lost due to premature death (YLLs) and years lived with disability (YLDs) [ 7 ] deaths were defined as the number of deaths occurring in a population during a specific period. Pancreatitis is the inflammation of the pancreas. Acute pancreatitis includes active inflammation and pancreatic injury, leading to severe upper abdominal pain and nausea, vomiting and inappropriate release of pancreatic fluid, or systemic inflammatory response syndrome with fever and hypotension, and in some cases, failure of one or more organs. Chronic pancreatitis refers to the permanent damage to the pancreas caused by long-term or repeated inflammation, which can lead to chronic or occasional abdominal pain and nausea, and ultimately lead to the failure of the pancreas to produce and release digestive enzymes and hormones, leading to chronic diarrhea, food malnutrition and diabetes. In addition, patients with chronic pancreatitis may also have a superimposed attack of acute pancreatitis. In GBD 2019, the IHME continues to use the method of GBD 2017 to model acute pancreatitis and chronic pancreatitis respectively. In GBD 2019, systematic literature search strategies are being used to obtain worldwide studies on the prevalence and incidence rate of pancreatitis. In addition to the literature studies, both databases included administrative data that were extracted as incidence for acute and prevalence for chronic pancreatitis. The exclusion criteria were:1) The studies are not clearly representative of the national population; 2) The study did not provide fundamental data on epidemiological parameters. Case definition was based on appropriate ICD coding or combined with clinical, biochemical and radiological criteria were included. In the GBD 2019 framework, acute and chronic pancreatitis are modeled as separate causes; however, for the purposes of this analysis, estimates were aggregated and presented as “pancreatitis” to show the total population burden of pancreatic cancer while enabling comparisons of pancreatic cancer across countries and different time periods. Meta regression was employed to synthesize and adjust data to address systematic difference across studies. Meta regression—Bayesian, regularized, trimmed (MR-BRT) models were applied to harmonize data by accounting for variations in study design, case definitions, and measurement approaches across locations and time periods. This approach reduces the risk of attributing methodological heterogeneity. MR-BRT analysis yielded male-to-female prevalence ratios of 0.81 (95%CI: 0.54, 1.20) for acute pancreatitis and 0.66 (95%CI: 0.36, 1.22) for chronic pancreatitis. As in GBD 2017, the DisMod-MR 2.1 model was used to estimate prevalence and incidence by age, sex, year and country/ region. Predictive covariates included log-transformed summary exposure values for pancreatitis prevalence as well as indicators of health care access and quality (HAQ) and excess mortality rate (EMR). For acute pancreatitis, covariates included the alcohol consumed per capita on incidence and health care availability, and EMR. Mortality due to pancreatitis was modeled using the standard Cause of Death Ensemble model (CODEm), with location-specific covariates. Final estimates of years of life lost (YLLs) were derived by integrating unadjusted results from both global models and data-rich models, followed by adjustment using CodCorrect. Uncertainty was quantified through 1,000 ordered draws at each computational step, thereby incorporating variability from input data, measurement error correction, and residual non-sampling error [ 10 ]. 95% uncertainty intervals (UIs) were reported as the 25th and 97.5th percentiles of the ordered draws. We analyzed the global burden of pancreatitis in terms of prevalence, incidence, mortality, DALYs, and YLLS. The cutoff points for HDI were selected based on the Human Development Report 2020. Risk factors were assessed using the following variables: alcohol consumption (annual volume of pure alcohol per capita); smoking (daily or occasional); obesity [body mass index (BMI) ≥ 30 kg/m2]; inadequate physical activity (≤ 150 min/week of moderate intensity; ≤ 75 min/week of vigorous-intensity exercise); hypertension (systolic blood pressure ≥ 140 mmHg or diastolic blood pressure ≥ 90 mmHg); diabetes (fasting glucose ≥ 7.0 mmol/L, diabetes history, or use of insulin or oral hypoglycemic drugs); and hypercholesterolemia (total cholesterol ≥ 5.0 mmol/L) [ 11 ]. Disability weights were derived from GBD disability weight survey, which provides sequelae-specific descriptions, emphasizing the major functional limitations and symptoms [ 12 ]. ICD10(K85-K86.9) and ICD9(577-577.9) were used to identify cases of pancreatitis. All cases of acute pancreatitis disease model are given a single or combined disability weight for severe abdominal pain and severe infectious disease symptoms; the cases of chronic pancreatitis disease model were divided into symptomatic and asymptomatic groups on the basis of literatures of published study about the nature history of chronic pancreatitis. The symptomatic group further divided into mild, moderate, and severe groups [ 12 ]. YLDs were calculated as the product of disease prevalence and the corresponding disability weight for each health state. Years of life lost (YLLs) were calculated by multiplying the estimated number of deaths by the standard life expectancy at the age of death. Years lived with disability (YLDs) were calculated by multiplying each specific sequela prevalence by the corresponding disability weight [ 13 ]. DALY were then computed as the sum of YLLs and YLDs. The treatment of age standardization of each epidemiological indicator can be used for comparison between subjects with differences in age structure or for the same population undergoes a corresponding change in age structure over time, and is calculated as follows [ 14 ] \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$\begin{aligned} ASR=\frac{{\displaystyle\sum_{i=1}^A}a_iw_i}{{\displaystyle\sum_{i=1}^A}w_i}\times100,000\end{aligned}$$\end{document} Where \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$\:{a}_{i}$$\end{document} , denotes the rate in the \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$\:{i}^{th}$$\end{document} age class, and \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$\:{w}_{i}$$\end{document} represents the standard population weights for that group. The estimate annual percentage change (EAPC) is an important widely used index to assess the trend of ASR changes over a given time interval, it can be obtained from the regression line model for natural logarithm of ASR [ 14 , 15 ]. It was calculated using the following equation: \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$y=\alpha+\beta\times+\;\epsilon$$\end{document} where \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$\:y$$\end{document} refers to ln (ASR), \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$\:x$$\end{document} represents calendar year, and \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$\:\epsilon\:$$\end{document} represents error term, the coefficient β reflects the positive or negative trend of ASR. The EAPC was calculated with the formula EAPC = 100 × (exp(β)-1), and 95% confidence intervals were obtained from the model. The ASR was considered to have an upward trend when the EAPC and lower confidence limit were > 0. Conversely, the ASR showed a decreasing trend was inferred if the EAPC and its upper confidence bound below 0. The correlation between SDI with ASR was evaluated using Pearson correlation coefficient, and smoothing spline model was fitted to the expected relationship of SDI with ASR from 1990 to 2019 across 205 countries. All statistical analyses were conducted in the R program (version 4.0.3). A two-tailed p value < 0.05 was considered statistically significant.

Our analysis of data from 204 countries demonstrated higher incidences, prevalence, and DALYs in pancreatitis, whereas pancreatic cancer exhibited a high mortality rate. Alcohol consumption, smoking, elevated BMI, obesity, hypertension, and dyslipidemia showed a positive correlation with both conditions. Sex-specific differences were evident, with men consistently facing higher incidence and mortality risks. SDI demonstrated a direct correlation with the incidence and prevalence but an inverse association with mortality, underscoring the role of healthcare access and quality. These findings highlight opportunities for policymakers to prioritize prevention and early detection strategies targeting modifiable lifestyle and metabolic risk factors—particularly alcohol and tobacco control, obesity prevention, and cardiovascular risk management—should be prioritized within integrated non-communicable disease strategies. In parallel, strengthening healthcare systems through improved screening, timely diagnostic pathways, and equitable access to specialized care is essential, especially in low- and middle-SDI settings where mortality remains disproportionately high. Efficient allocation of healthcare resources—tailored to the regional prevalence and impact of pancreatitis and pancreatic cancer—will be essential to improving outcomes worldwide. Generally, these results demonstrate the need for integrated prevention and care strategies that combine risk factor modification with health system strengthening. Such approaches are essential for reducing the global burden of pancreatitis and pancreatic cancer and for achieving health equality between different population groups and geographical regions.

To our knowledge, this study represents the first GBD-based analysis to jointly evaluate the global burden, temporal trends, and risk factors of pancreatitis and pancreatic cancer using GBD 2019 framework, enabling direct comparison of two clinically linked but epidemiologically distinct pancreatic diseases. Unlike prior GBD 2017 or disease-specific reports that examined these conditions independently, our simultaneous assessment highlights both shared and divergent epidemiological patterns between two clinically related yet etiologically distinct pancreatic diseases. Our study also developed its complete global disease burden estimates by combining data from 204 countries on incidence, prevalence, mortality, DALYs, and modifiable risk factors which were collected between 1990 and 2019. This comparative approach provides new insight into how differences in age distribution, mortality structure, and socioeconomic gradients shape disease burden across regions, providing actionable information for policy-making and targeted prevention measures. In this study, we found that the global prevalence, incidence, mortality and DALYs of pancreatitis have all increased. The age-standardized prevalence rate of pancreatitis rose in most regions between1990 and 2019, with the steepest increase in Eastern Europe, South Africa, North Africa and Middle East, whereas China experienced the largest decrease, mainly driven by females [ 16 ]. In China, clear sex-specific differences were observed. Men developed pancreatitis at younger ages, whereas deaths were concentrated among older adults, resulting in a DALY burden dominated by years of life lost. The burden of DALYs was primarily attributable to YLLs. Globally, the age-standardized incidence rate in Europe and North America is still the highest in the world; Eastern Europe the highest prevalence, and Eastern Europe and West Africa the highest mortality. China was examined separately because of its large population size, substantial contribution to global case numbers, and rapid demographic and epidemiological transitions over the past three decades [ 16 ]. The research found that higher SDI levels associated with increased incidence and prevalence but lower mortality rates and YLLs according to existing research findings which showed that high-income countries had better disease diagnostic capacity and improved survival times. China experienced a lower overall burden of pancreatitis than worldwide statistics showed because of its high total number of pancreatitis cases. For pancreatic cancer, high-income regions had the highest prevalence, incidence and mortality for both sexes. This aligns with findings from GBD 2017, which characterized pancreatic cancer is mainly a disease of high-income countries [ 17 ]. The highest incidence of both pancreatic cancer and pancreatitis recorded in North America and the lowest recorded in Eastern Mediterranean region and Southeast Asia [ 18 ]. Previous studies have attributed these disparities [ 16 ] to differences in dietary patterns with high-calorie and high-fat diet more in high-income regions as well as to underdiagnosis and limited cancer registration in low-resource setting [ 19 ]. In-depth analysis from the international pancreatic cancer case control consortium (Panc4) has revealed a twofold increased risk of pancreatic cancer associated with cigarette smoking, with the risk escalating in proportion to the number of cigarettes smoked and the duration of smoking. These patterns show common geographic and behavioral risk structures which exist between the two diseases but not completely identical with our pancreatitis research findings [ 20 ]. In this study, the global age-standardized prevalence, incidence and DALYs for pancreatitis were 29.3, 34.8, and 44.4 per 100,000, respectively. A previous study using GBD 2017 data reported higher prevalence and incidence of pancreatitis were 76.2 cases per 100,000 people (95% UI: 68.9 to 83.4) but lower incidence 20.6 cases per 100,000 people (95% UI 19.2 to 22.1) [ 10 ]. These discrepancies are partly explained by the inclusion of additional hospital discharge and claims data in GBD 2019, improved redistribution of ill-defined causes, and refinements to DisMod-MR 2.1 that enhanced internal consistency across epidemiological parameters. Moreover, the use of MR-BRT allowed more flexible bias adjustment combined with covariate selection, contributing to recalibration of incidence and prevalence estimates across regions [ 21 , 22 ]. In China, although crude disease rates increased overtime, age-standardized mortality declined, reflecting improvements in clinical management and access to healthcare [ 3 , 23 ]. Sex specific differences were evident for both pancreatitis and pancreatic cancer [ 18 ], with men demonstrating a higher risk for the incidence and mortality of pancreatitis and pancreatic cancer [ 24 , 25 ]. Lifestyle-related exposure, particularly smoking and excessive alcohol consumption, which are known risk factors for these diseases [ 24 ]. Studies on the independent effects of smoking and alcohol on pancreatitis remains mixed, a growing body of literature supports smoking as a risk factor for both acute and chronic pancreatitis [ 3 , 18 ], whereas alcohol appears to increase the risk primarily at high level of consumption [ 24 , 26 – 28 ]. In China, where male drinking rates far exceed those of females and tobacco use is widespread [ 3 , 4 , 9 ] the burden of pancreatitis attributed to drinking is mainly from men, while women remain stable. The smoking situation is even worse [ 29 , 30 ]. The difference in etiological subtypes between the sexes may ultimately affect the difference in pancreatitis between the sexes. Additionally, hormonal differences may play a role, as estrogen in women may offer some protection against pancreatic diseases [ 31 ]. Although most age-standardized indicators (incidence, prevalence, mortality and DALYs) have declined globally over a study period, absolute numbers continue to rise due to population size and aging. Age-stratified analyses revealed distinct regional patterns that have not been emphasized in prior global assessments. In addition, age stratified analysis of the affected population revealed that a greater proportion of endpoint pancreatitis between 10 and 24 years and over 75 years of age tended to occur in some specific In high-income regions, such as Western Europe, high-income Asia Pacific, Australia, and high-income North America, pancreatitis cases were disproportionately concentrated among individuals aged over 75 years and older; whereas a higher a proportion occurred among adolescents and young adults aged 10–24 in some African and South Asian regions. These contrasting age distributions likely reflect a large economic gap between the regions, risk exposure, and healthcare access, underscoring the need for region-specific prevention and management strategies [ 24 ]. Alcohol consumption, high BMI, dyslipidemia, hypertension, obesity, smoking, physical inactivity and total cholesterol were positively correlated with pancreatic cancer burden across all measured outcomes. These associations are consistent with GBD 2017 and other international analyses [ 17 , 32 ]. Most of these risk factors were also correlated with pancreatitis except physical inactivity. Physical inactivity increases the risk of pancreatic cancer due to prolonged exposure to inflammation, insulin resistance, factors linked to cancer development [ 33 ]. Research on mechanistic and nutritional pathways further supports the role of modifiable metabolic and dietary factors in pancreatic carcinogenesis. A recent comprehensive review by Niu et al. highlighted that plant-derived flavonoids exert anti–pancreatic cancer effects through different mechanisms, including lower chronic inflammation, control lipid metabolism, induction of apoptosis, and inhibition of tumor growth and spread. These findings provide biological plausibility for the associations between metabolic risk factors and pancreatic cancer burden and indicates the potential value of diet-based preventive measures alongside traditional risk factor management [ 34 ]. To the best of our knowledge it is the first study conducted on both pancreatitis and pancreatic cancer epidemiological pattern and its attributable factors worldwide. There are also several limitations to this study; first, under-reporting in low- and middle-income countries may underestimate disease burden, although GBD methodology applies standardized adjustments across data sources. Second, pediatric pancreatitis is increasingly recognized, yet was not the focus of this study. Acute pancreatitis incidence in children ranges between 3 and 13 per 100,000 annually, highlighting the need for future research [ 35 , 36 ]. This study mainly focused on the burden status of pancreatitis and pancreatic cancer in adults, highlighting the need for future research on peadiatric pateints. Third, the GBD 2019 model separates acute and chronic pancreatitis but our study presents combined data for all pancreatitis cases. This method was chosen to measure the total population-level burden of pancreatic inflammatory disease and to facilitate comparison with pancreatic cancer. However, acute and chronic pancreatitis differ substantially in underlying course, disease progression, and long-term outcomes. The aggregation of these entities may obscure subtype-specific epidemiological patterns and risk factor associations. Future research needs using GBD subcause-specific outputs or primary clinical data to study the differences and to better inform subtype-tailored prevention and management strategies. Finally, this study used multiple geographic classification schemes, which served as distinct analytical purposes. Nonetheless, presenting results across different spatial scales may complicate interpretation, and future research should establish to more countries.

Pancreatitis and pancreatic cancer are two common and serious disorders in all pancreatic diseases. Pancreatitis is an inflammatory disorder of the pancreas, whereas pancreatic cancer is a highly aggressive malignant tumor with poor prognosis [ 1 ]. Most pancreatic cancer patients have distant metastasis at the time of diagnosis and the 5-year survival rate is only 10% in the United States and it’s becoming a common cause of cancer mortality. Patients with pancreatic cancer presented with advanced disease due to lack of or vague symptoms when the cancer is still localized [ 2 ]. Generally, both pancreatitis and pancreatic cancer have been more prevalent in high-income countries. However, due to the rapid development of economic and social development, the global patterns and trends of disease is undergoing transition [ 3 ]. These epidemiological shifts underscore the need to reassess the global burden of pancreatitis and pancreatic cancer and to guide the health system planning in regions undergoing rapid transition. The recurrent episodes of acute pancreatitis and chronic pancreatitis has been associated with increased risk of pancreatic cancer, while pancreatic cancer may initially present as acute pancreatitis, potentially delaying cancer diagnosis [ 4 – 6 ]. Moreover, chronic inflammation has become recognized as the primary biological link between these two diseases. Inflammatory process starts carcinogenesis, while pancreatic tumors cause inflammatory responses by producing pro-inflammatory cytokines [ 5 , 6 ]Sadr-Azodi et al. observed that the 769 people with pancreatic cancer, 70% had at least one prior episode of acute pancreatitis and the recurrence of acute pancreatitis seems to increase the risk for developing pancreatic cancer [ 7 ]. Alcohol consumption and smoking are among the most consistently reported risk factors for both pancreatitis and pancreatic cancer, while gallstones are a predominant cause of pancreatitis [ 5 , 6 ]. In addition, obesity, physical inactivity, hypertension and hypercholesterolemia all functions as metabolic and lifestyle elements which increase the risk of developing pancreatic cancer. The factors exist together which lead to disease development and progression [ 5 ]. The epidemiological characteristics of disease is described by the prevalence, incidence, and mortality of disease; and the burden of disease is determined by disability-adjusted life year (DALY), which includes years of life lost due to premature mortality (YLLs) and years of healthy life lost due to disability (YLDs) [ 4 ]. The Global Burden of Disease (GBD) study used the Sociodemographic Index (SDI) as a tool to define disease burden because the index measures three variables of income and educational attainment and fertility rates. SDI has been shown to correlate strongly with key health outcomes such as life expectancy, mortality, and DALYs [ 8 , 9 ]. The GBD suggests that policy makers in countries that may experience changes in disease burden characteristics because of epidemiological transition should evaluate the effectiveness of policies by comparing international health outcomes with the health outcomes of sociodemographic development alone [ 4 ]. The study presents global and regional estimates through GBD 2019 geographic framework, including GBD regions and Socio-demographic Index (SDI) quintiles as its primary presentation method. GBD regions were used to describe the difference between various regions, while SDI quintiles served as a method to examine socioeconomic gradients in disease burden [ 9 ]. Investigating disparities in the epidemiology of pancreatic cancer and pancreatitis is of paramount significance for several reasons. Firstly, it helps to understand the unequal burden of these diseases on different populations and identify vulnerable populations who may be at a higher risk of developing these conditions due to socioeconomic, genetic, or environmental factors. This knowledge can inform targeted prevention and intervention strategies for early detection and management. Secondly, understanding these differences helps researchers delve deeper into the underlying causes of these diseases. It can uncover connections between lifestyle factors, genetic predispositions, and environmental exposures, leading to more precise risk assessments and targeted interventions. Such insights can inform strategies to reduce the overall burden of pancreatic diseases. Additionally, studying both pancreatic cancer and pancreatitis in the context of disparities can highlight commonalities and distinctions between the two conditions. This study finding may reveal shared risk factors or pathways, enabling the development of multifaceted prevention and treatment approaches that benefit both patient groups. Addressing disparities in the epidemiology and risk factors of these diseases is not only crucial for improving healthcare equity but also for advancing our understanding and management of pancreatic cancer and pancreatitis, potentially leading to more effective interventions and better outcomes for patients. To our knowledge, comprehensive global estimates comparing prevalence, incidence, mortality, years life lost, disability-adjusted life-years, and associated risk factors among pancreatic cancer and pancreatitis remains limited. Therefore, this study will determine the global burden of pancreatic cancer and pancreatitis and its associated factors.

Supplementary Material 1. Figure S1 Prevalence, Incidence, YLDs (Years Lived with Disability), and YLLs (Years of Life Lost) rates by age groups of pancreatitis from 1990-2019. Supplementary Material 1. Figure S1 Prevalence, Incidence, YLDs (Years Lived with Disability), and YLLs (Years of Life Lost) rates by age groups of pancreatitis from 1990-2019. Supplementary Material 2. Figure S2 Prevalence, Incidence, YLDs, and YLLs of pancreatic cancer by age groups from 1990-2019. Supplementary Material 2. Figure S2 Prevalence, Incidence, YLDs, and YLLs of pancreatic cancer by age groups from 1990-2019. Supplementary Material 3. Figure S3 Correlation analysis between prevalence, incidence, death, DALYs, YLDs, YLLs of pancreatitis and its related risk factors. Supplementary Material 3. Figure S3 Correlation analysis between prevalence, incidence, death, DALYs, YLDs, YLLs of pancreatitis and its related risk factors. Supplementary Material 4. Figure S4 Correlation analysis between prevalence, incidence, death, DALYs, YLDs, YLLs of pancreatic cancer and its related risk factors. Supplementary Material 4. Figure S4 Correlation analysis between prevalence, incidence, death, DALYs, YLDs, YLLs of pancreatic cancer and its related risk factors.