Griffiths Robert I, Lindquist Karla J, O'Malley Cynthia D, Gleeson Michelle L, Duryea Jennifer L, Valderas José M, Danese Mark D
Nuffield Department of Primary Care Health Sciences, University of Oxford, 23-38 Hythe Bridge Street, 2nd Floor, Oxford OX1 2ET, UK ; Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA.
Department of Epidemiology, Outcomes Insights, Inc., Westlake Village, CA 91362, USA.
ISRN Oncol. 2014 Mar 4;2014:607850. doi: 10.1155/2014/607850. eCollection 2014.
Our study describes the incidence and risk factors for undiagnosed diabetes in elderly cancer patients. Using Surveillance, Epidemiology, and End Results-Medicare data, we followed patients with breast, colorectal, lung, or prostate cancer from 24 months before to 3 months after cancer diagnosis. Medicare claims were used to exclude patients with diabetes 24 to 4 months before cancer (look-back period), identify those with diabetes undiagnosed until cancer, and construct indicators of preventive services, physician contact, and comorbidity during the look-back period. Logistic regression analyses were performed to identify factors associated with undiagnosed diabetes. Overall, 2,678 patients had diabetes undiagnosed until cancer. Rates were the highest in patients with both advanced-stage cancer and low prior primary care/medical specialist contact (breast 8.2%, colorectal 5.9%, lung 4.4%). Nonwhite race/ethnicity, living in a census tract with a higher percent of the population in poverty and a lower percent college educated, lower prior preventive services use, and lack of primary care and/or medical specialist care prior to cancer all were associated with higher (P ≤ 0.05) adjusted odds of undiagnosed diabetes. Undiagnosed diabetes is relatively common in selected subgroups of cancer patients, including those already at high risk of poor outcomes due to advanced cancer stage.
我们的研究描述了老年癌症患者未诊断糖尿病的发病率及危险因素。利用监测、流行病学和最终结果-医疗保险数据，我们对乳腺癌、结直肠癌、肺癌或前列腺癌患者从癌症诊断前24个月至诊断后3个月进行了随访。医疗保险理赔数据用于排除癌症前24至4个月患有糖尿病的患者（回顾期），识别那些直到患癌症才被诊断出糖尿病的患者，并构建回顾期内预防服务、医生接触和合并症的指标。进行逻辑回归分析以确定与未诊断糖尿病相关的因素。总体而言，2678名患者直到患癌症才被诊断出患有糖尿病。在晚期癌症患者和先前初级保健/医学专科医生接触较少的患者中，发病率最高（乳腺癌8.2%，结直肠癌5.9%，肺癌4.4%）。非白人种族/族裔、生活在贫困人口比例较高且大学学历人口比例较低的普查区、先前预防服务使用率较低以及癌症前缺乏初级保健和/或医学专科护理，均与未诊断糖尿病的调整后较高比值比相关（P≤0.05）。未诊断糖尿病在特定癌症患者亚组中相对常见，包括那些因癌症晚期本已面临不良结局高风险的患者。
