Joseph Dimitri F, Li Ellen, Stanley Iii Samuel L, Zhu Yi-Cong, Li Xiao-Ning, Yang Jie, Ottaviano Lorenzo F, Bucobo Juan Carlos, Buscaglia Jonathan M, Miller Joshua D, Veluvolu Rajesh, Follen Michele, Grossman Evan B
Department of Medicine, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY 11794-8173, United States.
Department of Medicine, Division of Gastroenterology, Stony Brook University, Stony Brook, NY 11794-8173, United States.
World J Clin Cases. 2021 Apr 16;9(11):2433-2445. doi: 10.12998/wjcc.v9.i11.2433.
The Black/African Ancestry (AA) population has a higher prevalence of type 2 diabetes mellitus (T2DM) and a higher incidence and mortality rate for colorectal cancer (CRC) than all other races in the United States. T2DM has been shown to increase adenoma risk in predominantly white/European ancestry (EA) populations, but the effect of T2DM on adenoma risk in Black/AA individuals is less clear. We hypothesize that T2DM has a significant effect on adenoma risk in a predominantly Black/AA population.
To investigate the effect of T2DM and race on the adenoma detection rate (ADR) in screening colonoscopies in two disparate populations.
A retrospective cohort study was conducted on ADR during index screening colonoscopies (age 45-75) performed at an urban public hospital serving a predominantly Black/AA population (92%) (2017-2018, = 1606). Clinical metadata collected included basic demographics, insurance, body mass index (BMI), family history of CRC, smoking, diabetes diagnosis, and aspirin use. This dataset was combined with a recently reported parallel retrospective cohort data set collected at a suburban university hospital serving a predominantly White/EA population (87%) (2012-2015, = 2882).
The ADR was higher in T2DM patients than in patients without T2DM or prediabetes (35.2% 27.9%, = 0.0166, = 981) at the urban public hospital. Multivariable analysis of the combined datasets showed that T2DM [odds ratio (OR) = 1.29, 95% confidence interval (CI): 1.08-1.55, = 0.0049], smoking (current never OR = 1.47, 95%CI: 1.18-1.82, current past OR = 1.32, 95%CI: 1.02-1.70, = 0.0026, older age (OR = 1.05 year, 95%CI: 1.04-1.06, < 0.0001), higher BMI (OR = 1.02 unit, 95%CI: 1.01-1.03, = 0.0003), and male sex (OR = 1.87, 95%CI: 1.62-2.15, < 0.0001 were associated with increased ADR in the combined datasets, but race, aspirin use and insurance were not.
T2DM, but not race, is significantly associated with increased ADR on index screening colonoscopy while controlling for other factors.
在美国，黑人/非裔血统（AA）人群中2型糖尿病（T2DM）的患病率较高，结直肠癌（CRC）的发病率和死亡率也高于所有其他种族。在以白人/欧洲血统（EA）为主的人群中，T2DM已被证明会增加腺瘤风险，但T2DM对黑人/AA个体腺瘤风险的影响尚不清楚。我们假设T2DM对以黑人/AA为主的人群的腺瘤风险有显著影响。
研究T2DM和种族对两个不同人群筛查结肠镜检查中腺瘤检出率（ADR）的影响。
对一家主要服务于黑人/AA人群（92%）的城市公立医院进行的初次筛查结肠镜检查（年龄45 - 75岁）期间的ADR进行回顾性队列研究（2017 - 2018年，n = 1606）。收集的临床元数据包括基本人口统计学信息、保险情况、体重指数（BMI）、CRC家族史、吸烟情况、糖尿病诊断和阿司匹林使用情况。该数据集与最近报道的在一家主要服务于白人/EA人群（87%）的郊区大学医院收集的平行回顾性队列数据集合并（2012 - 2015年，n = 2882）。
在城市公立医院，T2DM患者的ADR高于无T2DM或糖尿病前期的患者（35.2%对27.9%，P = 0.0166，n = 981）。对合并数据集的多变量分析显示，T2DM [优势比（OR）= 1.29，95%置信区间（CI）：1.08 - 1.55，P = 0.0049]、吸烟（当前吸烟vs从不吸烟OR = 1.47，95%CI：1.18 - 1.82，当前吸烟vs既往吸烟OR = 1.32，95%CI：1.02 - 1.70，P = 0.0026）、年龄较大（OR = 1.05/岁，95%CI：1.04 - 1.06，P < 0.0001）、BMI较高（OR = 1.02/单位，95%CI：1.01 - 1.03，P = 0.0003）和男性性别（OR = 1.87，95%CI：1.62 - 2.15，P < 0.0001）与合并数据集中ADR增加相关，但种族、阿司匹林使用和保险情况无关。
在控制其他因素的情况下，T2DM而非种族与初次筛查结肠镜检查时ADR增加显著相关。
