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Social and economic development processes require large amounts of natural resources and in some cases seriously deteriorate river water quality. Since the reform and expansion era began, China has vigorously pursued socioeconomic development but neglected environmental protection. However, in recent years, improvements in environmental awareness and the implementation of environmental protection measures have led to a balanced relationship between economic development and the environment. In this study, the Yangtze River Basin and the Y

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PEPC was associated with older age (≥ 75 years compared with  5, OR 1.90, 95 %CI 1.49-2.43), chronic pancreatitis (OR 3.13, 95 %CI 2.50-3.92), and diabetes mellitus (OR 1.58, 95 %CI 1.31-1.9. Metal biliary stents (OR 0.57, 95 %CI 0.38-0.86) and EUS-FNA (OR 0.49, 95 %CI 0.41-0.58) were inversely associated with PEPC. PEPC was associated with a higher cumulative mortality at 1 year (hazard ratio 1.12, 95 %CI 1.02-1.24), with only 14 % of PEPC patients (95 %CI 12 %-17 %) having a surgical resection, compared with 21 % (95 %CI 20 %-22