美国糖尿病和癌症的社会和种族不平等。

Social and racial inequalities in diabetes and cancer in the United States.

机构信息

Epidemiology and Population Health Department, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon.

Department of Biochemistry and Molecular Genetics, Faculty of Medicine, American University of Beirut, Beirut, Lebanon.

出版信息

Front Public Health. 2023 Jul 19;11:1178979. doi: 10.3389/fpubh.2023.1178979. eCollection 2023.

DOI:10.3389/fpubh.2023.1178979

PMID:37538273

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10395076/

Abstract

BACKGROUND

Cancer and diabetes are among the leading causes of morbidity and mortality worldwide. Several studies have reported diabetes as a risk factor for developing cancer, a relationship that may be explained by associated factors shared with both diseases such as age, sex, body weight, smoking, and alcohol consumption. Social factors referred to as social determinants of health (SDOH) were shown to be associated with the risk of developing cancer and diabetes. Despite that diabetes and social factors were identified as significant determinants of cancer, no studies examined their combined effect on the risk of developing cancer. In this study, we aim at filling this gap in the literature by triangulating the association between diabetes, indices of SDOH, and the risk of developing cancer.

METHODS

We have conducted a quantitative study using data from the Behavioral Risk Factor Surveillance System (BRFSS), whereby information was collected nationally from residents in the United States (US) with respect to their health-related risk behaviors, chronic health conditions, and the use of preventive services. Data analysis using weighted regressions was conducted on 389,158 study participants.

RESULTS

Our findings indicated that diabetes is a risk factor that increases the likelihood of cancer by 13% (OR 1.13; 95%CI: 1.05-1.21). People of White race had higher odds for cancer compared to African Americans (OR 0.44; 95%CI: 0.39-0.49), Asians (OR 0.27; 95%CI: 0.20-0.38), and other races (OR 0.56; 95%CI: 0.46-0.69). The indices of SDOH that were positively associated with having cancer encompassed unemployment (OR 1.78; 95%CI: 1.59-1.99), retirement (OR 1.54; 95%CI: 1.43-1.67), higher income levels with ORs ranging between 1.16-1.38, college education (OR 1.10; 95%CI: 1.02-1.18), college graduates (OR 1.31; 95%CI: 1.21-1.40), and healthcare coverage (OR 1.44; 95%CI: 1.22-1.71). On the other hand, the indices of SDOH that were protective against having cancer were comprised of renting a home (OR 0.86; 95%CI: 0.79-0.93) and never married (OR 0.73; 95%CI: 0.65-0.81).

CONCLUSION

This study offers a novel social dimension for the association between diabetes and cancer that could guide setting strategies for addressing social inequities in disease prevention and access to healthcare.

摘要

背景

癌症和糖尿病是全球发病率和死亡率的主要原因。多项研究报告糖尿病是癌症发病的一个风险因素，这种关系可能与这两种疾病共有的相关因素有关，如年龄、性别、体重、吸烟和饮酒。被称为健康社会决定因素的社会因素与癌症发病风险有关。尽管糖尿病和社会因素被确定为癌症的重要决定因素，但没有研究检查它们对癌症发病风险的综合影响。在这项研究中，我们旨在通过三角测量糖尿病、社会决定因素指标与癌症发病风险之间的关联来填补这一文献空白。

方法

我们使用来自美国行为风险因素监测系统（BRFSS）的数据进行了一项定量研究，该系统从美国居民那里收集了与他们的健康相关的风险行为、慢性健康状况和预防服务使用情况有关的信息。对 389158 名研究参与者的数据进行了加权回归分析。

结果

我们的研究结果表明，糖尿病是一种风险因素，会使癌症的发病几率增加 13%（OR 1.13；95%CI：1.05-1.21）。与非裔美国人（OR 0.44；95%CI：0.39-0.49）、亚洲人（OR 0.27；95%CI：0.20-0.38）和其他种族（OR 0.56；95%CI：0.46-0.69）相比，白人患癌症的几率更高。与癌症发生呈正相关的社会决定因素指数包括失业（OR 1.78；95%CI：1.59-1.99）、退休（OR 1.54；95%CI：1.43-1.67）、收入水平较高（OR 1.16-1.38）、接受大学教育（OR 1.10；95%CI：1.02-1.18）、大学毕业（OR 1.31；95%CI：1.21-1.40）和获得医疗保健（OR 1.44；95%CI：1.22-1.71）。另一方面，与癌症发生呈负相关的社会决定因素指数包括租房（OR 0.86；95%CI：0.79-0.93）和未婚（OR 0.73；95%CI：0.65-0.81）。