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The incidence of pancreatic neuroendocrine neoplasms (NENs) is rising; whether this reflects a true increase in disease occurrence or improved detection remains uncertain. We conducted a retrospective, population-based study using data from the Surveillance, Epidemiology, and End Results (SEER) Program (1975-2021) to examine temporal trends in the incidence of pancreatic NENs and assess whether changes reflect improved detection versus a true increase. Incidence trends were stratified by demographic and socioeconomic proxies of healthcare access, including income, residential setting, and race as recorded in SEER at the county level. We identified 16,253 cases of pancreatic NENs (44.6% women; median age 62 years). Incidence increased 7.75-fold between 1975 and 2021, rising from 0.21 cases per 100,000 population in 1975 to 1.58 per 100,000 in 2021. Median tumour size at diagnosis decreased significantly, with an average annual reduction of 0.73 mm (R² = 0.765; p < 0.001). After adjustment, incidence increased more steeply among men, individuals aged 40-65 years and >65 years (vs. <40 years), those recorded as White (vs. Black and other races), individuals with higher income, and those residing in urban (vs. rural) counties. Incidence also rose more steeply for tumours located in the pancreatic tail, for grade 1 tumours (vs. grades 2 and 3), and for smaller tumours (vs. larger ones). The rising incidence of pancreatic NENs is probably explained by improved detection, particularly among populations with greater access to healthcare, rather than by a true increase in disease occurrence.