Department of Public Health, and Department of National Clinical Research Center for Child Health, The Children's Hospital, Zhejiang University School of Medicine, Hangzhou, China.
Department of Public Health, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
Diabetologia. 2023 Aug;66(8):1450-1459. doi: 10.1007/s00125-023-05920-9. Epub 2023 May 13.
AIMS/HYPOTHESIS: The age-specific associations between type 2 diabetes and cancer risk are not fully understood. The aim of this study was to assess how age at diagnosis modifies the associations between type 2 diabetes and cancer risk.
We used data from the Yinzhou Health Information System, and included 42,279 individuals who were newly diagnosed with type 2 diabetes between 2010 and 2014, as well as 166,010 age- and sex-matched control individuals without diabetes who were selected randomly from the electronic health records of the entire population. Patients were divided into four age groups according to age at diagnosis: <50, 50-59, 60-69 and ≥70 years. Stratified Cox proportional hazards regression models, with age as the time scale, were used to estimate the HRs and 95% CIs for the associations of type 2 diabetes with the risks of overall and site-specific cancers. Population-attributable fractions were also calculated for outcomes associated with type 2 diabetes.
During median follow-up periods of 9.20 and 9.32 years, we identified 15,729 incident cancer cases and 5383 cancer deaths, respectively. Patients diagnosed with type 2 diabetes before 50 years of age had the highest relative risks of cancer incidence and mortality, with HRs (95% CI) of 1.35 (1.20, 1.52) for overall cancer incidence, 1.39 (1.11, 1.73) for gastrointestinal cancer incidence, 2.02 (1.50, 2.71) for overall cancer mortality, and 2.82 (1.91, 4.18) for gastrointestinal cancer mortality. Risk estimates decreased gradually with each decade increase in diagnostic age. The population-attributable fractions for overall cancer and gastrointestinal cancer mortality also decreased with increasing age.
CONCLUSIONS/INTERPRETATION: The associations of type 2 diabetes with cancer incidence and mortality varied by age at diagnosis, with a higher relative risk among patients who were diagnosed at a younger age.
目的/假设：2 型糖尿病与癌症风险之间的年龄特异性关联尚不完全清楚。本研究的目的是评估诊断时的年龄如何改变 2 型糖尿病与癌症风险之间的关联。
我们使用了鄞州区健康信息系统的数据，纳入了 2010 年至 2014 年间新诊断为 2 型糖尿病的 42279 例患者，以及从整个人群的电子健康记录中随机选择的 166010 名年龄和性别匹配的无糖尿病对照个体。患者根据诊断时的年龄分为四组：<50 岁、50-59 岁、60-69 岁和≥70 岁。使用分层 Cox 比例风险回归模型，以年龄为时间尺度，估计 2 型糖尿病与总体和特定部位癌症风险之间的关联的 HRs 和 95%CI。还计算了与 2 型糖尿病相关的结局的人群归因分数。
在中位随访期为 9.20 和 9.32 年期间，我们分别确定了 15729 例新发癌症病例和 5383 例癌症死亡病例。诊断年龄<50 岁的患者癌症发病和死亡的相对风险最高，总体癌症发病率的 HR（95%CI）为 1.35（1.20，1.52），胃肠道癌症发病率的 HR 为 1.39（1.11，1.73），总体癌症死亡率的 HR 为 2.02（1.50，2.71），胃肠道癌症死亡率的 HR 为 2.82（1.91，4.18）。诊断年龄每增加 10 年，风险估计值逐渐下降。总体癌症和胃肠道癌症死亡率的人群归因分数也随年龄的增加而降低。
结论/解释：2 型糖尿病与癌症发病率和死亡率的关联因诊断时的年龄而异，诊断年龄较轻的患者相对风险更高。
