1
|
Tønder JE, Bønnelykke-Behrndtz ML, Laurberg T, Røssell EL, Sollie M. Melanoma risk, tumour stage, and melanoma-specific mortality in individuals with diabetes: a systematic review and meta-analysis. BMC Cancer 2024; 24:812. [PMID: 38972968 PMCID: PMC11229239 DOI: 10.1186/s12885-024-12598-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Accepted: 07/03/2024] [Indexed: 07/09/2024] Open
Abstract
BACKGROUND Cancer has become the leading diabetes-related cause of death in high-income countries, and more knowledge is needed to clarify the impact of diabetes on site-specific cancers. The purpose of this study is to assess the association between diabetes and malignant melanoma by conducting a comprehensive systematic review and meta-analysis. METHODS Using predefined eligibility criteria, PubMed, The Cochrane Library and Web of Science were systematically searched up to February 22, 2023. Exposure was defined as diabetes or type 2 diabetes and the outcomes were defined as melanoma incidence, melanoma stage or melanoma-specific mortality. The identified articles were evaluated by two independent reviewers and quality assessment was conducted using the Newcastle-Ottawa Scale for observational studies. Meta-analyses were conducted using RevMan 5.4.1 on melanoma risk using adjusted risk estimates and on melanoma stage using a dichotomous model. RESULTS The literature search revealed 20 studies in total eligible for inclusion, 14 for the analysis of melanoma risk, 3 for melanoma thickness and ulceration, and 4 for melanoma-specific survival. According to the meta-analyses, diabetes did not impact the risk of developing melanoma (RR:1.05, 95%CI:0.99-1.12, p = 0.10). However, type 2 diabetes was associated with more advanced melanoma stages at the time of diagnosis (Breslow-thickness > 1 mm: RR 1.35, 95%CI: 1.22-1.49, p = < 0.001) and presence of ulceration (RR 1.30, 95%CI: 1.00-1.68, p = 0.05). A meta-analysis on the association between diabetes and melanoma-specific mortality was not feasible due to diverse study designs. CONCLUSION Our meta-analysis found no association between diabetes and the risk of developing melanoma, but diabetes was associated with increased tumour thickness and the presence of ulceration at the time of diagnosis. Further research is warranted to explore the association between diabetes melanoma stage and prognosis. TRIAL REGISTRATION PROSPERO ID CRD42023394187.
Collapse
Affiliation(s)
- Jens Ejrnæs Tønder
- Department of Plastic and Breast Surgery, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, Aarhus N, 8200, Denmark.
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark.
| | | | - Tinne Laurberg
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark
- Department of Pathology, Aarhus University Hospital, Aarhus, Denmark
| | - Eeva-Liisa Røssell
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark
- Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Martin Sollie
- Department of Plastic and Breast Surgery, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, Aarhus N, 8200, Denmark
| |
Collapse
|
2
|
Ahmadinezhad M, Arshadi M, Hesari E, Sharafoddin M, Azizi H, Khodamoradi F. The relationship between metabolic syndrome and its components with bladder cancer: a systematic review and meta-analysis of cohort studies. Epidemiol Health 2022; 44:e2022050. [PMID: 35638225 PMCID: PMC9684010 DOI: 10.4178/epih.e2022050] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Accepted: 05/30/2022] [Indexed: 11/09/2022] Open
Abstract
A previous meta-analysis, entitled "The association between metabolic syndrome and bladder cancer susceptibility and prognosis: an updated comprehensive evidence synthesis of 95 observational studies involving 97,795,299 subjects," focused on all observational studies, whereas in the present meta-analysis, we focused on cohort studies to obtain more accurate and stronger evidence to evaluate the association between metabolic syndrome and its components with bladder cancer. PubMed, Embase, Scopus, and Web of Science were searched to identify studies on the association between metabolic syndrome and its components with bladder cancer from January 1, 2000 through May 23, 2021. The pooled relative risk (RR) and 95% confidence intervals (CI) were used to measure this relationship using a random-effects meta-analytic model. Quality appraisal was undertaken using the Newcastle-Ottawa Scale. In total, 56 studies were included. A statistically significant relationship was found between metabolic syndrome and bladder cancer 1.09 (95% CI, 1.02 to 1.17), and there was evidence of moderate heterogeneity among these studies. Our findings also indicated statistically significant relationships between diabetes (RR, 1.23; 95% CI, 1.16 to 1.31) and hypertension (RR, 1.07; 95% CI, 1.01 to 1.13) with bladder cancer, but obesity and overweight did not present a statistically significant relationship with bladder cancer. We found no evidence of publication bias. Our analysis demonstrated statistically significant relationships between metabolic syndrome and the risk of bladder cancer. Furthermore, diabetes and hypertension were associated with the risk of bladder cancer.
Collapse
Affiliation(s)
- Mozhgan Ahmadinezhad
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Maedeh Arshadi
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Elahe Hesari
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Maedeh Sharafoddin
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Hosein Azizi
- Research Center of Psychiatry and Behavioral Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Farzad Khodamoradi
- Department of Social Medicine, Faculty of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| |
Collapse
|
3
|
Yan P, Wang Y, Yu X, Liu Y, Zhang ZJ. Type 2 diabetes mellitus and risk of head and neck cancer subtypes: a systematic review and meta-analysis of observational studies. Acta Diabetol 2021; 58:549-565. [PMID: 33389127 DOI: 10.1007/s00592-020-01643-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Accepted: 11/20/2020] [Indexed: 02/06/2023]
Abstract
AIMS The association between type 2 diabetes mellitus (T2DM) and risk of head and neck cancer (HNC) remains unclear. This study aims to perform a system review and meta-analysis to explore this relationship. METHODS PubMed, Web of Science, and Embase databases were searched for studies published up to July 31, 2020, regarding the association between T2DM and HNC risk. A random-effects model was utilized to calculate summary relative risks (RRs) with corresponding 95% confidence intervals (CIs). RESULTS Fourteen case-control studies and thirteen cohort studies were included in our analysis. We observed a weak association between T2DM and risk of HNC overall, but there was no statistical significance (RR, 1.04; 95% CI, 0.88-1.23; I2 = 83.2%). Interestingly, there was a strong association in East Asia (RR, 1.46; 95% CI, 1.21-1.77; I2 = 36.6%). For HNC subtypes, T2DM conferred a significantly elevated risk in oral cancer (RR, 1.22; 95% CI, 1.01-1.47; I2 = 89.0%). However, in subgroup analyses of smoking, alcohol use, and body mass index (BMI)/obesity adjustments, the association between T2DM and oral cancer risk became insignificant. In addition, T2DM was not associated with a statistically elevated risk of pharyngeal cancer (RR, 1.18; 95% CI, 0.94-1.49; I2 = 72.9%) and laryngeal cancer (RR, 1.03; 95% CI, 0.88-1.22; I2 = 71.2%). CONCLUSIONS This meta-analysis indicates that T2DM is associated with an increased risk of HNC in East Asia. As for site-specific cancer types, the risk of oral cancer was significantly increased in T2DM patients, which appear to be mediated or confounded by smoking, alcohol use, or BMI/obesity.
Collapse
Affiliation(s)
- Pengfei Yan
- Department of Preventive Medicine, School of Health Sciences, Wuhan University, No. 185 Donghu Road, Wuhan, 430071, China
| | - Yongbo Wang
- Department of Preventive Medicine, School of Health Sciences, Wuhan University, No. 185 Donghu Road, Wuhan, 430071, China
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Xue Yu
- Department of Preventive Medicine, School of Health Sciences, Wuhan University, No. 185 Donghu Road, Wuhan, 430071, China
| | - Yu Liu
- Department of Statistics and Management, School of Management, Wuhan Institute of Technology, Wuhan, 430205, China
| | - Zhi-Jiang Zhang
- Department of Preventive Medicine, School of Health Sciences, Wuhan University, No. 185 Donghu Road, Wuhan, 430071, China.
| |
Collapse
|
4
|
Häggström C, Van Hemelrijck M, Garmo H, Robinson D, Stattin P, Rowley M, Coolen AC, Holmberg L. Heterogeneity in risk of prostate cancer: A Swedish population-based cohort study of competing risks and Type 2 diabetes mellitus. Int J Cancer 2018; 143:1868-1875. [PMID: 29744858 PMCID: PMC6220128 DOI: 10.1002/ijc.31587] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Revised: 04/13/2018] [Accepted: 04/27/2018] [Indexed: 12/12/2022]
Abstract
Most previous studies of prostate cancer have not taken into account that men in the studied populations are also at risk of competing event, and that these men may have different susceptibility to prostate cancer risk. The aim of our study was to investigate heterogeneity in risk of prostate cancer, using a recently developed latent class regression method for competing risks. We further aimed to elucidate the association between Type 2 diabetes mellitus (T2DM) and prostate cancer risk, and to compare the results with conventional methods for survival analysis. We analysed the risk of prostate cancer in 126,482 men from the comparison cohort of the Prostate Cancer Data base Sweden (PCBaSe) 3.0. During a mean follow-up of 6 years 6,036 men were diagnosed with prostate cancer and 22,393 men died. We detected heterogeneity in risk of prostate cancer with two distinct latent classes in the study population. The smaller class included 9% of the study population in which men had a higher risk of prostate cancer and the risk was stronger associated with class membership than any of the covariates included in the study. Moreover, we found no association between T2DM and risk of prostate cancer after removal of the effect of informative censoring due to competing risks. The recently developed latent class for competing risks method could be used to provide new insights in precision medicine with the target to classify individuals regarding different susceptibility to a particular disease, reaction to a risk factor or response to treatment.
Collapse
Affiliation(s)
- Christel Häggström
- Department of Surgical SciencesUppsala UniversityUppsalaSweden
- Department of Biobank ResearchUmeå UniversityUmeåSweden
- King's College London, School of Cancer and Pharmaceutical SciencesTranslational Oncology & Urology Research (TOUR)LondonUnited Kingdom
| | - Mieke Van Hemelrijck
- King's College London, School of Cancer and Pharmaceutical SciencesTranslational Oncology & Urology Research (TOUR)LondonUnited Kingdom
- Institute of Environmental MedicineKarolinska InstituteStockholmSweden
| | - Hans Garmo
- King's College London, School of Cancer and Pharmaceutical SciencesTranslational Oncology & Urology Research (TOUR)LondonUnited Kingdom
- Regional Cancer Centre Uppsala/ÖrebroUppsalaSweden
| | | | - Pär Stattin
- Department of Surgical SciencesUppsala UniversityUppsalaSweden
| | - Mark Rowley
- Institute for Mathematical and Molecular BiomedicineKing's College LondonLondonUnited Kingdom
- Saddle Point ScienceLondonUnited Kingdom
| | - Anthony C.C. Coolen
- Institute for Mathematical and Molecular BiomedicineKing's College LondonLondonUnited Kingdom
| | - Lars Holmberg
- Department of Surgical SciencesUppsala UniversityUppsalaSweden
- King's College London, School of Cancer and Pharmaceutical SciencesTranslational Oncology & Urology Research (TOUR)LondonUnited Kingdom
| |
Collapse
|
5
|
Ohkuma T, Peters SAE, Woodward M. Sex differences in the association between diabetes and cancer: a systematic review and meta-analysis of 121 cohorts including 20 million individuals and one million events. Diabetologia 2018; 61:2140-2154. [PMID: 30027404 PMCID: PMC6133170 DOI: 10.1007/s00125-018-4664-5] [Citation(s) in RCA: 106] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 05/02/2018] [Indexed: 12/14/2022]
Abstract
AIMS/HYPOTHESIS Diabetes has been shown to be a risk factor for some cancers. Whether diabetes confers the same excess risk of cancer, overall and by site, in women and men is unknown. METHODS A systematic search was performed in PubMed for cohort studies published up to December 2016. Selected studies reported sex-specific relative risk (RR) estimates for the association between diabetes and cancer adjusted at least for age in both sexes. Random-effects meta-analyses with inverse-variance weighting were used to obtain pooled sex-specific RRs and women-to-men ratios of RRs (RRRs) for all-site and site-specific cancers. RESULTS Data on all-site cancer events (incident or fatal only) were available from 121 cohorts (19,239,302 individuals; 1,082,592 events). The pooled adjusted RR for all-site cancer associated with diabetes was 1.27 (95% CI 1.21, 1.32) in women and 1.19 (1.13, 1.25) in men. Women with diabetes had ~6% greater risk compared with men with diabetes (the pooled RRR was 1.06, 95% CI 1.03, 1.09). Corresponding pooled RRRs were 1.10 (1.07, 1.13) for all-site cancer incidence and 1.03 (0.99, 1.06) for all-site cancer mortality. Diabetes also conferred a significantly greater RR in women than men for oral, stomach and kidney cancer, and for leukaemia, but a lower RR for liver cancer. CONCLUSIONS/INTERPRETATION Diabetes is a risk factor for all-site cancer for both women and men, but the excess risk of cancer associated with diabetes is slightly greater for women than men. The direction and magnitude of sex differences varies by location of the cancer.
Collapse
Affiliation(s)
- Toshiaki Ohkuma
- The George Institute for Global Health, University of New South Wales, Level 10, King George V Building, Royal Prince Alfred Hospital, Missenden Rd, Camperdown, NSW, 2050, Australia.
| | - Sanne A E Peters
- The George Institute for Global Health, University of Oxford, Le Gros Clark Building, South Parks Road, Oxford, OX1 3QX, UK
| | - Mark Woodward
- The George Institute for Global Health, University of New South Wales, Level 10, King George V Building, Royal Prince Alfred Hospital, Missenden Rd, Camperdown, NSW, 2050, Australia.
- The George Institute for Global Health, University of Oxford, Le Gros Clark Building, South Parks Road, Oxford, OX1 3QX, UK.
- Department of Epidemiology, Johns Hopkins University, Baltimore, MD, USA.
| |
Collapse
|
6
|
Wild SH, Walker JJ, Morling JR, McAllister DA, Colhoun HM, Farran B, McGurnaghan S, McCrimmon R, Read SH, Sattar N, Byrne CD, Wild SH, Walker JJ, Morling JR, McAllister DA, Colhoun H, Farran B, McGurnaghan S, McCrimmon R, Read SH, Sattar N, Byrne CD, Lindsay R, Leese G, McKnight J, Petrie J, Chalmers J, Fischbacher C, Cunningham S, Wu O, Philip S. Cardiovascular Disease, Cancer, and Mortality Among People With Type 2 Diabetes and Alcoholic or Nonalcoholic Fatty Liver Disease Hospital Admission. Diabetes Care 2018; 41:341-347. [PMID: 29167212 DOI: 10.2337/dc17-1590] [Citation(s) in RCA: 79] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Accepted: 10/20/2017] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To describe associations between alcoholic liver disease (ALD) or nonalcoholic fatty liver disease (NAFLD) hospital admission and cardiovascular disease (CVD), cancer, and mortality in people with type 2 diabetes mellitus (T2DM). RESEARCH DESIGN AND METHODS We performed a retrospective cohort study by using linked population-based routine data from diabetes registry, hospital, cancer, and death records for people aged 40-89 years diagnosed with T2DM in Scotland between 2004 and 2013 who had one or more hospital admission records. Liver disease and outcomes were identified by using ICD-9 and ICD-10 codes. We estimated hazard ratios (HRs) from Cox proportional hazards regression models, adjusting for key risk factors. RESULTS A total of 134,368 people with T2DM (1,707 with ALD and 1,452 with NAFLD) were studied, with a mean follow-up of 4.3 years for CVD and 4.7 years for mortality. Among those with ALD, NAFLD, or without liver disease hospital records 378, 320, and 21,873 CVD events; 268, 176, and 15,101 cancers; and 724, 221, and 16,203 deaths were reported, respectively. For ALD and NAFLD, respectively, adjusted HRs (95% CIs) compared with the group with no record of liver disease were 1.59 (1.43, 1.76) and 1.70 (1.52, 1.90) for CVD, 40.3 (28.8, 56.5) and 19.12 (11.71, 31.2) for hepatocellular carcinoma (HCC), 1.28 (1.12, 1.47) and 1.10 (0.94, 1.29) for non-HCC cancer, and 4.86 (4.50, 5.24) and 1.60 (1.40, 1.83) for all-cause mortality. CONCLUSIONS Hospital records of ALD or NAFLD are associated to varying degrees with an increased risk of CVD, cancer, and mortality among people with T2DM.
Collapse
Affiliation(s)
- Sarah H. Wild
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, U.K
| | - Jeremy J. Walker
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, U.K
| | - Joanne R. Morling
- Division of Epidemiology and Public Health, University of Nottingham, Nottingham, U.K
| | - David A. McAllister
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, U.K
| | - Helen M. Colhoun
- Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, U.K
| | - Bassam Farran
- Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, U.K
| | - Stuart McGurnaghan
- Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, U.K
| | - Rory McCrimmon
- Division of Molecular and Clinical Medicine, University of Dundee, Dundee, U.K
| | - Stephanie H. Read
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, U.K
| | - Naveed Sattar
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, U.K
| | - Christopher D. Byrne
- Nutrition and Metabolism, Faculty of Medicine, University of Southampton, Southampton, U.K
- National Institute for Health Research Southampton Biomedical Research Centre, University Hospital Southampton, Southampton, U.K
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
7
|
Häggström C, Van Hemelrijck M, Zethelius B, Robinson D, Grundmark B, Holmberg L, Gudbjörnsdottir S, Garmo H, Stattin P. Prospective study of Type 2 diabetes mellitus, anti-diabetic drugs and risk of prostate cancer. Int J Cancer 2017; 140:611-617. [PMID: 27770555 PMCID: PMC5215657 DOI: 10.1002/ijc.30480] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Revised: 09/11/2016] [Accepted: 10/06/2016] [Indexed: 12/11/2022]
Abstract
Type 2 diabetes mellitus (T2DM) has consistently been associated with decreased risk of prostate cancer; however, if this decrease is related to the use of anti-diabetic drugs is unknown. We prospectively studied men in the comparison cohort in the Prostate Cancer data Base Sweden 3.0, with data on T2DM, use of metformin, sulfonylurea and insulin retrieved from national health care registers and demographic databases. Cox proportional hazards regression models were used to compute hazard ratios (HR) and 95% confidence intervals (CI) of prostate cancer, adjusted for confounders. The study consisted of 612,846 men, mean age 72 years (standard deviation; SD = 9 years), out of whom 25,882 men were diagnosed with prostate cancer during follow up, mean time of 5 years (SD = 3 years). Men with more than 1 year's duration of T2DM had a decreased risk of prostate cancer compared to men without T2DM (HR = 0.85, 95% CI = 0.82-0.88) but among men with T2DM, those on metformin had no decrease (HR = 0.96, 95% CI = 0.77-1.19), whereas men on insulin (89%) or sulfonylurea (11%) had a decreased risk (HR = 0.73, 95% CI = 0.55-0.98), compared to men with T2DM not on anti-diabetic drugs. Men with less than 1 year's duration of T2DM had no decrease in prostate cancer risk (HR = 1.11, 95% CI = 0.95-1.31). Our results gave no support to the hypothesis that metformin protects against prostate cancer as recently proposed. However, our data gave some support to an inverse association between T2DM severity and prostate cancer risk.
Collapse
Affiliation(s)
- Christel Häggström
- Department of Surgical and Perioperative SciencesUrology and Andrology, Umeå UniversityUmeåSweden
- Department of Surgical SciencesUppsala UniversityUppsalaSweden
- Department of Biobank ResearchUmeå UniversityUmeåSweden
| | - Mieke Van Hemelrijck
- Division of Cancer StudiesKing's College London, Faculty of Life Sciences and MedicineLondonUnited Kingdom
- Institute of Environmental MedicineKarolinska InstituteStockholmSweden
| | - Björn Zethelius
- Department of Public Health and Caring Sciences/GeriatricsUppsala UniversityUppsalaSweden
- Department of Scientific SupportMedical Products AgencyUppsalaSweden
| | - David Robinson
- Department of Surgical and Perioperative SciencesUrology and Andrology, Umeå UniversityUmeåSweden
| | | | - Lars Holmberg
- Division of Cancer StudiesKing's College London, Faculty of Life Sciences and MedicineLondonUnited Kingdom
- Department of Surgical SciencesRegional Cancer Centre Uppsala/ÖrebroUppsalaSweden
| | - Soffia Gudbjörnsdottir
- Department of MedicineSahlgrenska University Hospital, Gothenburg UniversityGöteborgSweden
| | - Hans Garmo
- Division of Cancer StudiesKing's College London, Faculty of Life Sciences and MedicineLondonUnited Kingdom
- Department of Surgical SciencesRegional Cancer Centre Uppsala/ÖrebroUppsalaSweden
| | - Pär Stattin
- Department of Surgical and Perioperative SciencesUrology and Andrology, Umeå UniversityUmeåSweden
- Department of Surgical SciencesUppsala UniversityUppsalaSweden
| |
Collapse
|
8
|
Type 2 diabetes and gender differences in liver cancer by considering different confounding factors: a meta-analysis of cohort studies. Ann Epidemiol 2016; 26:764-772. [PMID: 27765402 DOI: 10.1016/j.annepidem.2016.09.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2015] [Revised: 08/24/2016] [Accepted: 09/16/2016] [Indexed: 12/24/2022]
Abstract
PURPOSE Questions remain uncertainty regarding the gender differences in the relationship between type 2 diabetes (T2DM) and liver cancer risk. By considering several confounding factors, we aimed to identify this issue according to a meta-analysis of cohort studies. METHODS We searched EMBASE and MEDLINE for studies on the association between T2DM and risk of liver cancer up to November 30, 2014. A random-effects model was performed to calculate summary relative risks (SRRs) with corresponding 95% confidence intervals (CIs). RESULTS A total of 24 cohort studies (including more than 20,000 liver cancer cases) were recruited. T2DM was associated with an elevated liver cancer incidence in both men (SRR = 2.16; 95% CI, 1.74-2.69) and women (SRR = 1.85; 95% CI, 1.40-2.44). Stratified analyses showed that the risk associations were significantly stronger in non-Asian than those in Asian for both men and women. Both tobacco smoking and body mass index were significant confounding factors for the T2DM-liver cancer association in men, whereas alcohol use was not the case. The SRR estimates of liver cancer mortality with T2DM were statistically significant in both men and women (men: SRR = 2.26; 95% CI, 1.60-3.19 and women: SRR = 2.01; 95% CI, 1.45-2.74). CONCLUSIONS Results of this meta-analysis indicate that the T2DM-liver cancer correlation is confounded by smoking and body mass index in both men and women. Results also suggest a significantly stronger T2DM-liver cancer correlation in non-Asian than that in Asian for both men and women.
Collapse
|
9
|
Abstract
There are an increasing number of clinical, administrative and trial databases that can be used for research. These are particularly valuable if there are opportunities for linkage to other databases. This paper describes examples of the use of large diabetes databases for research. It reviews the advantages and disadvantages of using large diabetes databases for research and suggests solutions for some challenges. Large, high-quality databases offer potential sources of information for research at relatively low cost. Fundamental issues for using databases for research are the completeness of capture of cases within the population and time period of interest and accuracy of the diagnosis of diabetes and outcomes of interest. The extent to which people included in the database are representative should be considered if the database is not population based and there is the intention to extrapolate findings to the wider diabetes population. Information on key variables such as date of diagnosis or duration of diabetes may not be available at all, may be inaccurate or may contain a large amount of missing data. Information on key confounding factors is rarely available for the nondiabetic or general population limiting comparisons with the population of people with diabetes. However comparisons that allow for differences in distribution of important demographic factors may be feasible using data for the whole population or a matched cohort study design. In summary, diabetes databases can be used to address important research questions. Understanding the strengths and limitations of this approach is crucial to interpret the findings appropriately.
Collapse
Affiliation(s)
- Sarah Wild
- Usher institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - Colin Fischbacher
- Information Services Division, NHS National Services Scotland, Edinburgh, UK
| | - John McKnight
- Metabolic Unit, Western General Hospital, Edinburgh, UK
| |
Collapse
|
10
|
Wild SH, Morling JR, McAllister DA, Kerssens J, Fischbacher C, Parkes J, Roderick PJ, Sattar N, Byrne CD. Type 2 diabetes and risk of hospital admission or death for chronic liver diseases. J Hepatol 2016; 64:1358-64. [PMID: 26812073 DOI: 10.1016/j.jhep.2016.01.014] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Revised: 01/06/2016] [Accepted: 01/14/2016] [Indexed: 01/30/2023]
Abstract
BACKGROUND & AIMS The impact of type 2 diabetes (T2DM) on hospital admissions and deaths due to common chronic liver diseases (CLDs) is uncertain. Our aim was to investigate associations between T2DM and CLDs in a national retrospective cohort study and to investigate the role of sex and socio-economic status (SES). METHODS We used International Classification of Disease codes to identify incident alcoholic liver disease (ALD), autoimmune liver disease, haemochromatosis, hepatocellular carcinoma, non-alcoholic fatty liver disease (NAFLD) and viral liver disease from linked diabetes, hospital, cancer and death records for people of 40-89years of age in Scotland 2004-2013. We used quasi Poisson regression to estimate rate ratios (RR). RESULTS There were 6667 and 33624 first mentions of CLD in hospital, cancer and death records over ∼1.8 and 24million person-years in people with and without T2DM, respectively. The most common liver disease was ALD among people without diabetes and was NAFLD among people with T2DM. Age-adjusted RR for T2DM compared to the non-diabetic population (95% confidence intervals) varied between 1.27 (1.04-1.55) for autoimmune liver disease and 5.36 (4.41-6.51) for NAFLD. RRs were lower for men than women and for more compared to less deprived populations for both ALD and NAFLD. CONCLUSIONS T2DM is associated with increased risk of hospital admission or death for all common CLDs and the strength of the association varies by type of CLD, sex and SES. Increasing prevalence of T2DM is likely to result in increasing burden of all CLDs.
Collapse
Affiliation(s)
- Sarah H Wild
- Centre for Population Health Sciences, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, UK.
| | - Joanne R Morling
- Centre for Population Health Sciences, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, UK
| | - David A McAllister
- Centre for Population Health Sciences, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, UK
| | - Jan Kerssens
- Information Services Division, National Health Service National Services Scotland, Edinburgh, UK
| | - Colin Fischbacher
- Information Services Division, National Health Service National Services Scotland, Edinburgh, UK
| | - Julie Parkes
- Faculty of Medicine, University of Southampton, UK
| | - Paul J Roderick
- Primary Care and Population Sciences, University of Southampton, UK
| | - Naveed Sattar
- British Heart Foundation Centre for Cardiovascular Science, University of Glasgow, UK
| | - Christopher D Byrne
- Nutrition and Metabolism, Faculty of Medicine, University of Southampton, UK; NIHR Southampton Biomedical Research Centre, University Hospital Southampton, UK
| | | | | |
Collapse
|
11
|
Cancer among patients with type 2 diabetes mellitus: A population-based cohort study in northeastern Italy. Cancer Epidemiol 2016; 41:80-7. [PMID: 26851751 DOI: 10.1016/j.canep.2016.01.011] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Revised: 01/08/2016] [Accepted: 01/21/2016] [Indexed: 01/12/2023]
Abstract
Diabetes mellitus (DM) is associated with an elevated risk of cancer. The aim of this study was to assess cancer risk and survival in individuals with type 2 DM (T2DM) in Friuli Venezia Giulia, Italy. A retrospective population-based cohort study of 32,247 T2DM patients aged 40-84 years was conducted through a record linkage of local healthcare databases and cancer registry for the period 2002-2009. Standardized incidence ratios (SIRs) with 95% confidence intervals (95%CIs) and 5-year survival probabilities after T2DM and cancer diagnosis were computed. The SIRs for all cancers (n=2069) was 1.28 (95%CI: 1.23-1.34). The highest SIRs were observed for cancers of the liver, female genital organs, small intestine, and pancreas. After 3 years from T2DM diagnosis, a reduced risk of prostate cancer (SIR=0.73, 95%CI: 0.54-0.96) was found in men aged 65-74 years, and a higher risk for breast cancer (SIR=1.24, 95%CI: 1.00-1.52) was found among T2DM female patients. The overall 5-year survival after T2DM was 88.7%. Furthermore, T2DM appeared to have a negative effect on survival of women with breast cancer. This population-based study confirmed that T2DM patients are at increased risk of several cancers, and of premature death in women with breast cancer.
Collapse
|
12
|
Batabyal P, Vander Hoorn S, Christophi C, Nikfarjam M. Association of diabetes mellitus and pancreatic adenocarcinoma: a meta-analysis of 88 studies. Ann Surg Oncol 2014; 21:2453-62. [PMID: 24609291 DOI: 10.1245/s10434-014-3625-6] [Citation(s) in RCA: 101] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2013] [Indexed: 12/13/2022]
Abstract
BACKGROUND Pancreatic ductal adenocarcinoma (PDAC) is often diagnosed at an advanced, incurable stage. Previous epidemiological data suggests that diabetes mellitus (DM) is a risk factor for PDAC, which may be important in early detection. However, the strength of this association needs to be determined, taking into account a number of recently published studies. METHODS A systematic review of the association between DM and PDAC was undertaken by searching electronic databases and journal references from 1973 to 2013. Summary estimates were obtained separately for case-control and cohort studies by means of a 'random effects' approach. Data pertaining to the DM was recorded and plotted at both an individual and study level, with the relative risks (RR) pooled separately to determine the relationship of DM duration and PDAC. RESULTS A total of 88 independent studies, including 50 cohort and 39 case-control studies were examined. The overall summary-combined RR was 1.97 (95 % CI 1.78-2.18) with marked heterogeneity that could not be clearly attributed to any subgroup analyses. The risk of PDAC was greatest early after the diagnosis of DM but remained elevated long after the diagnosis. The individual-level RR ranged from 6.69 at less than 1 year to 1.36 at 10 years. CONCLUSION The results demonstrate a strong association between PDAC and recently diagnosed DM, which may be attributed to a paraneoplastic effect. However, the presence of diabetes also remains a modest risk factor for the development of PDAC long-term. Selective screening of patients with new-onset DM for PDAC needs to be considered.
Collapse
Affiliation(s)
- Pikli Batabyal
- Department of Surgery, University of Melbourne, Austin Health, LTB 8, 145 Studley Rd, Heidelberg, Melbourne, VIC, 3084, Australia
| | | | | | | |
Collapse
|