ArticleJournal of gastrointestinal cancer2026
State-Level Prevalence of Obesity/overweight and Pancreatic Cancer Incidence in the United States: An Ecological Analysis Using BRFSS, CDC WONDER and ACS for the Year 2021.
Article in Journal of gastrointestinal cancer, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
purposeWhile obesity is established as an individual-level risk factor for pancreatic cancer (PC), population-level associations remain unclear. This study examines whether state-level overweight/obesity (O/OV) prevalence corresponds with age-adjusted PC incidence across the United States.
methodsWe conducted an ecological, cross-sectional analysis using 2021 data from the Behavioral Risk Factor Surveillance System (BRFSS) for state-level O/OV prevalence (BMI ≥ 25 kg/m²) and CDC WONDER for age-adjusted incidence rates (AAIR) of PC per 100,000 population. Demographic covariates such as percentage of non-Hispanic Black (NHB) population and population ≥ 65 years old were extracted from American Community Survey (ACS) data. Prevalence of current smokers and diabetes were also extracted from BRFSS. As a descriptive exploratory approach, incidence rate ratios (IRR) were calculated relative to West Virginia (WV) which had the highest O/OV prevalence, 73.6%. For inferential analysis, a univariable ordinary least square (OLS) linear regression was used to determine the association between O/OV prevalence and PC incidence. Multivariable linear regression model was fitted to adjust for prevalence of age ≥ 65, NHB race/ethnicity, current smokers and diabetes prevalence.
resultsAcross 50 US jurisdictions, including DC, the mean O/OV prevalence was 67.72%, ranging from 55.4% in DC to 73.6% in WV. Florida was excluded from the complete-case analysis and OLS due to missing BRFSS values for O/OV. Twenty-nine states with O/OV prevalence lower than WV also had lower PC incidence (concordance) whereas 20 states including DC exhibited lower O/OV prevalence yet higher PC incidence (discordance). Univariable OLS model showed no statistically significant association between O/OV and AAIR (slope: -0.035, p = 0.56; R²=0.007). Multivariable OLS well fitted model showed no significant association between O/OV and AAIR. Only Black population proportion was significantly associated with PC incidence across the states.
conclusionsIn this study, state-level O/OV prevalence failed to demonstrate a statistically significant association with PC incidence. Proportion of Black population was significantly associated with increased PC incidence. These findings suggest that population-level PC risk is likely influenced by multiple interacting metabolic, behavioral, sociodemographic, environmental, and healthcare-related factors beyond obesity alone. Further longitudinal and multivariable studies are needed to better delineate the complex relationship between obesity and PC at the population level.
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