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Background Pancreatic neuroendocrine tumors (pNETs) are uncommon neoplasms, and contemporary U.S. population-level mortality evaluations for malignant endocrine neoplasms of the pancreas are limited. This study assessed long-term mortality trends and forecast future trajectories for malignant neoplasms of the endocrine pancreas using U.S. death-certificate data.Methods In this study, CDC WONDER Multiple Cause of Death public-use death certificate data from the USA were analyzed for 1999–2023. Deaths were identified using ICD-10 code C25.4 when listed anywhere on the death certificate. Age-adjusted mortality rates (AAMRs) per 1,000,000 population were standardized to the 2000 U.S. standard population. Joinpoint Regression Program estimated annual percent change (APC) using Monte Carlo permutation testing (two-tailed, P<0.05). ARIMA models generated 10-year forecasts.Results From 1999 to 2023, 1,912 deaths were attributed to pNETs (894 women; 1,018 men). Overall AAMR declined significantly in 2004–2019 (APC −12.38; 95% CI −25.46 to −11.25). Female AAMR decreased significantly in 1999–2019 (APC −11.08; 95% CI −13.30 to −10.09). Male AAMR decreased significantly in 2004–2019 (APC −13.27; 95% CI −19.54 to −11.85) and increased significantly in 2019–2023 (APC 18.94; 95% CI 0.56 to 72.06). Highest deaths occurred in California (181) and Texas (118). Forecasted overall AAMR in 2033 was 0.12 per 1,000,000 (95% prediction interval −0.65 to 0.90; lower bounds truncated at zero) ( IDDF2026-ABS-0332 Figure 1. Overall yearly ARIMA forecasts and by gender (AAMR) with 95% confidence bands. AAMR = age-adjusted mortality rate).Conclusions U.S. pNET-related mortality declined significantly from 2004 to 2019, with an upturn after 2019 (significant in males). Forecasts suggest low mortality through 2033, with substantial uncertainty and death-certificate coding limitations.Abstract IDDF2026-ABS-0332 Figure 1