采用竞争风险分析评估2型糖尿病与吸烟并存对日本男性癌症总死亡率的影响：田能-曽别津研究
Combination of type 2 diabetes and smoking increases total cancer mortality in Japanese men using competing risk analysis: the Tanno-Sobetsu study.
作者信息
Ohnishi Hirofumi, Saitoh Shigeyuki, Akasaka Hiroshi, Furukawa Tetsuaki, Mori Mitsuru, Miura Tetsuji
机构信息
1Department of Public Health, Sapporo Medical University School of Medicine, W-17, S-1, Chuo-ku, Sapporo, Hokkaido Japan.
2Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University School of Medicine, Sapporo, Japan.
出版信息
Diabetol Int. 2015 Aug 25;7(2):167-172. doi: 10.1007/s13340-015-0232-0. eCollection 2016 Jun.
AIMS
We assessed the impact of the combination of type 2 diabetes (T2DM) and smoking on total cancer mortality using cohort data of a general Japanese population.
METHODS
Of 1908 residents who received health checkups in two towns in 1994, 794 males were included as study participants. Smoking status was defined as three categories: never smoker, ex-smoker and current smoker. Individuals with T2DM were defined as individuals with fasting plasma glucose ≥7.0 mmol/l and/or receiving medication for T2DM. Participants were divided into six groups according to T2DM and smoking status: non-DM (NDM) and never smoker, NDM and ex-smoker, NDM and current smoker, DM and never smoker, DM and ex-smoker, and DM and current smoker groups. All participants were followed up for a maximum of 13 years. We calculated the hazard ratio (HR) using Cox's proportional hazard model and subhazard ratio (SHR) using competing risk regression analyses in each group.
RESULTS
During the follow-up period, there were 169 all-cause deaths (62 cancer deaths and 40 CVD deaths). When using Cox regression analysis, HRs were higher in the ex-smoker and current smoker groups than in the never-smoker group, and HRs were also higher in the DM groups than in the NDM groups. When using competing risk analysis, SHRs were almost the same as the HRs of Cox regression analysis (DM and ex-smoker 6.06, DM and current smoker 10.12).
CONCLUSIONS
The combination of T2DM and smoking is a strong risk factor for total cancer mortality in Japanese men.
目的
我们利用日本普通人群的队列数据，评估2型糖尿病（T2DM）与吸烟相结合对总癌症死亡率的影响。
方法
1994年在两个城镇接受健康检查的1908名居民中，794名男性被纳入作为研究参与者。吸烟状况被定义为三类：从不吸烟者、既往吸烟者和当前吸烟者。患有T2DM的个体被定义为空腹血糖≥7.0 mmol/l和/或正在接受T2DM治疗的个体。参与者根据T2DM和吸烟状况分为六组：非糖尿病（NDM）且从不吸烟者、NDM且既往吸烟者、NDM且当前吸烟者、糖尿病且从不吸烟者、糖尿病且既往吸烟者以及糖尿病且当前吸烟者组。所有参与者最长随访13年。我们使用Cox比例风险模型计算风险比（HR），并使用竞争风险回归分析计算每组的亚风险比（SHR）。
结果
在随访期间，共有169例全因死亡（62例癌症死亡和40例心血管疾病死亡）。使用Cox回归分析时，既往吸烟者和当前吸烟者组的HR高于从不吸烟者组，糖尿病组的HR也高于非糖尿病组。使用竞争风险分析时，SHR与Cox回归分析的HR几乎相同（糖尿病且既往吸烟者为6.06，糖尿病且当前吸烟者为10.12）。
结论
T2DM与吸烟相结合是日本男性总癌症死亡率的一个强有力的风险因素。
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