Center for Primary Health Care Research, Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden.
Department of Clinical Microbiology, Center of Diagnostic Investigations, Rigshospitalet, Copenhagen, Denmark.
PLoS One. 2023 Jul 21;18(7):e0288959. doi: 10.1371/journal.pone.0288959. eCollection 2023.
Neighborhood deprivation has been found associated with both type 2 diabetes and lung cancer. The aim of this study was to examine the potential association between neighborhood deprivation and lung cancer incidence or mortality in individuals diagnosed with type 2 diabetes. The results may identify a new risk or prognostic factor for lung cancer in this important subgroup and help develop a more contextual approach to prevention that includes neighborhood environment.
The study population included adults (n = 613,650) aged ≥ 30 years with type 2 diabetes during 2005 to 2018 in Sweden. Cox regression was used to compute hazard ratios (HRs) and 95% confidence intervals (95% CIs) for incidence or mortality of lung cancer associated with neighborhood deprivation. All models were conducted in both men and women and adjusted for individual-level characteristics (e.g. age, smoking- and alcohol-related comorbidities, sociodemographic factors). The cumulative incidence and mortality for lung cancer were 1.08% (95% CI, 1.06 to 1.11) and 0.93% (0.90 to 0.95), respectively, in the study population during the study period. Neighborhood deprivation was associated with both incidence and mortality of lung cancer in patients with type 2 diabetes independently of the individual-level characteristics. In the fully adjusted models, comparing high- with low-deprivation neighborhoods, the HRs for lung cancer incidence were 1.21 (1.10 to 1.33) in men and 1.08 (0.95 to 1.21) in women. The corresponding HRs for lung cancer mortality were 1.04 (1.00 to 1.07) in men and 0.97 (0.94 to 1.00) in women. Competing risk analyses including cardiovascular mortality attenuated the results.
In this large cohort of individuals with type 2 diabetes, we found higher lung cancer incidence and mortality in patients living in areas with high neighborhood deprivation, even after adjusting for individual-level characteristics. These findings may help develop a more contextual approach that includes the neighborhood environment when allocating resources for disease prevention and care in patients with type 2 diabetes. These findings could also help inform clinical care for patients with type 2 diabetes, particularly those living in deprived neighborhoods.
社区贫困与 2 型糖尿病和肺癌均相关。本研究旨在探究社区贫困与已确诊 2 型糖尿病患者肺癌发病或死亡之间的潜在关联。研究结果可能会为这一重要亚组人群的肺癌确定新的风险或预后因素，并有助于制定更具背景相关性的预防措施，包括社区环境。
研究人群包括 2005 年至 2018 年期间瑞典年龄≥30 岁、患有 2 型糖尿病的成年人（n=613650）。采用 Cox 回归计算与社区贫困相关的肺癌发病或死亡的风险比（HR）和 95%置信区间（95%CI）。所有模型均在男性和女性中进行，并针对个体水平特征（如年龄、与吸烟和饮酒相关的合并症、社会人口学因素）进行了调整。在研究期间，研究人群的肺癌累积发病率和死亡率分别为 1.08%（95%CI，1.06 至 1.11）和 0.93%（0.90 至 0.95）。社区贫困与 2 型糖尿病患者的肺癌发病和死亡均相关，与个体水平特征无关。在完全调整的模型中，与低贫困社区相比，高贫困社区的男性肺癌发病 HR 为 1.21（1.10 至 1.33），女性为 1.08（0.95 至 1.21）。男性肺癌死亡的相应 HR 为 1.04（1.00 至 1.07），女性为 0.97（0.94 至 1.00）。包括心血管死亡率的竞争风险分析削弱了这些结果。
在本项针对大量 2 型糖尿病患者的研究中，我们发现生活在社区贫困程度较高地区的患者肺癌发病和死亡风险更高，即使在调整了个体水平特征后也是如此。这些发现可能有助于制定更具背景相关性的方法，在为 2 型糖尿病患者分配疾病预防和护理资源时纳入社区环境。这些发现还可能为 2 型糖尿病患者的临床护理提供信息，尤其是生活在贫困社区的患者。
