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. 2021 Jan 6;16(1):e0244285.
doi: 10.1371/journal.pone.0244285. eCollection 2021.

Opioid use as a potential risk factor for pancreatic cancer in the United States: An analysis of state and national level databases

Usman Barlass  1 , Ameya Deshmukh  2 , Todd Beck  3 , Faraz Bishehsari  1
Affiliations

Opioid use as a potential risk factor for pancreatic cancer in the United States: An analysis of state and national level databases

Usman Barlass et al. PLoS One. .

Abstract

Pancreatic cancer (PC) rate is increasing in the U.S. The use of prescription and illicit opioids has continued to rise nationally in recent years as well. Opioids have been shown to have a deleterious effect on multiple types of cancer with recent data suggesting opium use as a risk factor for PC. Using national databases, we tested whether opioid usage pattern over time could explain the state and national-based variations in PC rates in the U.S. Opioid death rate (as a surrogate for prescription and illicit opioid use) was extracted from the CDCs Wonder online data through the Vital Statistics Cooperative Program. Incidence of pancreatic cancer was retrieved from the online CDCs data base gathered from the U.S. Cancer Statistics Working Group. Prevalence of obesity, tobacco and alcohol use was collected from Behavioral risk factor surveillance system. Mixed-effects regression models were used to test the association between levels of PC rate and opioid death/use rates during the years 1999-2016. A rise in PC was seen over time at the national and state levels. Similarly, the opioid death rates increased over time. Among other potential PC risk factors, only obesity prevalence showed an increase during the study period. A state's opioid death rate at 4 years prior significantly predicted initial incidence of PC (β = 0.1848, p<0.0001) and had a significant effect on the estimated annual change in the rate of PC (β = -.0193,p<0.0001). Opioid use may be an un-identified risk factor contributing to the increasing incidence of PC in the U.S. These novel findings need to be verified by population-based studies.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1
Incidence of pancreatic cancer (1999 and 2016), U.S Cancer Statistics Working group, and opioid death rate by state (1999 and 2016), CDC Wonder database (A) Pancreatic cancer incidence visualization by state in 1999, (B) Pancreatic cancer incidence visualization by state in 2016(C) Opioid death rate visualization by state in 1999, (D) Opioid death rate visualization by state in 2016, Reprinted from [MapChart.net] under a CC BY license, with permission from [Minas Giannekas], original copyright [2014].
Fig 2
Fig 2
(A) Incidence rate of pancreatic cancer over time per 100,000 people, State incidence rate of pancreatic cancer through the years 1999 to 2016, (B) Incidence rate of opioid death overtime per 100,000 people, State incidence rate of opioid death through the years 1999 to 2016, (C) A state with an opioid death rate in the 25th percentile in 1999 had an annual increase in PC that was 34 percent faster than a state at the median opioid death rate and 3.3 times faster than a state with an opioid death rate in the 75th percentile.
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