Department of Population and Public Health Sciences, Keck School of Medicine of University of Southern California, Los Angeles, California.
Epidemiology Program, University of Hawaii Cancer Center, Honolulu, Hawaii.
Cancer Res Commun. 2023 May 2;3(5):755-762. doi: 10.1158/2767-9764.CRC-22-0288. eCollection 2023 May.
Research on the association between type 2 diabetes (T2D) and bladder cancer (BCA) risk among non-European ancestry populations is sparse to nonexistent, and most prior studies rely on a single baseline assessment of T2D status.
We estimated the T2D-BCA association using the Multiethnic Cohort Study of 185,059 men and women in California and Hawaii. Participants were African American, European American, Japanese American, Latin American, and Native Hawaiian, ages 45-75 years at enrollment (1993-1996). T2D was assessed by self-report at baseline, follow-up surveys, and Medicare claims. Cases were identified using Surveillance, Epidemiology and End Results Program cancer registries through 2016. Associations were estimated by race/ethnicity using Cox proportional hazards regression. Adjusted attributable fractions (AAF) and cumulative absolute risk of bladder cancer were estimated across groups.
Over an average 19.7 years of follow-up 1,890 incident bladder cancer cases were diagnosed. Time-varying T2D was associated with bladder cancer in the multiethnic sample (HR = 1.17; 95% confidence interval, 1.05-1.30); however, the HR did not differ by race/ethnicity ( = 0.85). The AAF was 4.2% in the multiethnic sample and largest among Native Hawaiians (9.8%). Absolute risk of bladder cancer among European Americans without T2D was higher than all other groups with T2D.
T2D is significantly associated with bladder cancer risk in a multiethnic sample.
Those with T2D have higher incidence of bladder cancer, regardless of racial/ethnic group. Reducing T2D prevalence could substantially lower bladder cancer incidence among Native Hawaiians due to T2D being more common in this group. High absolute risk of bladder cancer among European Americans, regardless of T2D status, indicates that elevated bladder cancer risk in this group may be due to factors other than T2D. Future studies must explore reasons for this difference in incidence.
针对非欧洲血统人群中 2 型糖尿病（T2D）与膀胱癌（BCA）风险之间的关联，研究甚少甚至不存在，且多数既往研究仅依赖于 T2D 状态的单次基线评估。
我们利用加利福尼亚州和夏威夷州的多民族队列研究中 185059 名男性和女性的数据来估计 T2D-BCA 相关性。参与者为非裔美国人、欧洲裔美国人、日裔美国人、拉丁裔和夏威夷原住民，入组时年龄为 45-75 岁（1993-1996 年）。T2D 通过基线、随访调查和医疗保险索赔进行自我报告评估。通过 2016 年的监测、流行病学和最终结果计划癌症登记处确定病例。使用 Cox 比例风险回归按种族/民族估计相关性。在各组中估计膀胱癌的调整归因分数（AAF）和累积绝对风险。
在平均 19.7 年的随访期间，诊断出 1890 例膀胱癌新发病例。时变 T2D 与多民族样本中的膀胱癌相关（HR=1.17；95%置信区间，1.05-1.30）；然而，该 HR 不因种族/民族而异（ = 0.85）。多民族样本中的 AAF 为 4.2%，在夏威夷原住民中最大（9.8%）。无 T2D 的欧洲裔美国人的膀胱癌绝对风险高于所有其他 T2D 组。
T2D 与多民族样本中的膀胱癌风险显著相关。
患有 T2D 的人患膀胱癌的风险更高，无论其种族/民族群体如何。由于 T2D 在这个群体中更为常见，因此降低 T2D 的患病率可能会大大降低夏威夷原住民的膀胱癌发病率。无论 T2D 状态如何，欧洲裔美国人的膀胱癌绝对风险较高，表明该组膀胱癌风险升高可能不是由于 T2D 引起的。未来的研究必须探讨这种发病率差异的原因。
