Background: Pancreatic cancer is characterized by early and relentless tumor spread. This leads healthcare providers to consider pancreatic cancer a “distant disease.” However, local tumor progression within the pancreas can lead to substantial morbidity. This study defines the long-term morbidity from local and non-local disease progression in a large population-based cohort. Methods: We identified 21,500 Medicare beneficiaries diagnosed with pancreatic cancer between 2000-2011 in the Survival, Epidemiology and End Results database. Hospitalizations identified from Medicare claims were attributed to complications either local (biliary, upper GI ulcer/bleed, pain, pancreatic, radiation toxicity) or non-local (thromboembolic events, any cytopenia, dehydration, nausea/vomiting/motility, malnutrition and cachexia, ascites, pathologic fracture, chemotherapy toxicity) in nature. Competing risk analyses were used to determine the cumulative incidence of complications from local, and non-local disease. Multivariable Fine-Gray models were used to identify the impact of chemotherapy or radiotherapy on the risk of hospitalization. Results: Of the total cohort 9,347 (43.5%) patients were hospitalized for a local complication, and 13,101 (52.4%) for a non-local complication. After adjusting for the competing risk of death, complication due to local disease at 24-months post-diagnosis was highest in non-metastatic non-resection (55.1%), followed by non-metastatic resection (44%) and metastatic (34.5%) patients. Non-local complications were highest in non-metastatic non-resection (60.6%), followed by metastatic (58.6%) and non-metastatic resection (52.5%) patients. Predictors of hospitalization for local and non-local complications included age, race-ethnicity, location, patient group, tumor size and diagnosis year. Radiation and chemotherapy had minimal impact on risk of hospitalization. Conclusions: Despite the widely-known predilection of distant disease spread in pancreatic cancer, local tumor progression also leads to substantial morbidity and hospitalization. Radiation and chemotherapy did not decrease the rates of hospitalization for local complications.