2型糖尿病患者的收入动态与结直肠癌风险：一项基于全国人口的队列研究

Income Dynamics and Risk of Colorectal Cancer in Individuals With Type 2 Diabetes: A Nationwide Population-based Cohort Study.

作者信息

Park Yong-Moon Mark, Amick Iii Benjamin C, McElfish Pearl A, Brown Clare C, Schootman Mario, Narcisse Marie-Rachelle, Lee Seong-Su, Choi Yoon Jin, Han Kyungdo

机构信息

Department of Epidemiology, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences.

Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences.

出版信息

J Epidemiol. 2025 Jan 5;35(1):30-38. doi: 10.2188/jea.JE20230310. Epub 2024 Nov 30.

DOI:10.2188/jea.JE20230310

PMID:38972733

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11637811/

Abstract

BACKGROUND

Individuals with type 2 diabetes mellitus (T2DM) have increased colorectal cancer (CRC) risk, but it is unknown whether income dynamics are associated with CRC risk in these individuals. We examined whether persistent low- or high-income and income changes are associated with CRC risk in non-elderly adults with T2DM.

METHODS

Using nationally representative data from the Korean Health Insurance Service database, 1,909,492 adults aged 30 to 64 years with T2DM and no history of cancer were included between 2009 and 2012 (median follow-up of 7.8 years). We determined income levels based on health insurance premiums and assessed annual income quartiles for the baseline year and the four preceding years. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated after adjusting for sociodemographic factors, CRC risk factors, and diabetes duration and treatment.

RESULTS

Persistent low income (ie, lowest income quartile) was associated with increased CRC risk (HR 1.11; 95% CI, 1.04-1.18; P for trend = 0.004). Income declines (ie, a decrease ≥25% in income quantile) were also associated with increased CRC risk (HR 1.10; 95% CI, 1.05-1.16; P for trend = 0.001). In contrast, persistent high income (ie, highest income quartile) was associated with decreased CRC risk (HR 0.81; 95% CI, 0.73-0.89; P for trend < 0.0001), which was more pronounced for rectal cancer (HR 0.64; 95% CI, 0.53-0.78) and distal colon cancer (HR 0.70; 95% CI, 0.57-0.86).

CONCLUSION

Our findings underscore the need for increased public policy awareness of the association between income dynamics and CRC risk in adults with T2DM.

摘要

背景

2型糖尿病（T2DM）患者患结直肠癌（CRC）的风险增加，但尚不清楚收入动态变化是否与这些患者的CRC风险相关。我们研究了持续的低收入或高收入以及收入变化是否与非老年T2DM成人的CRC风险相关。

方法

利用韩国健康保险服务数据库中的全国代表性数据，纳入了2009年至2012年期间1909492名年龄在30至64岁之间、患有T2DM且无癌症病史的成年人（中位随访时间为7.8年）。我们根据健康保险费确定收入水平，并评估基线年份及之前四年的年收入四分位数。在调整社会人口学因素、CRC风险因素以及糖尿病病程和治疗情况后，估计风险比（HR）和95%置信区间（CI）。

结果

持续低收入（即收入最低四分位数）与CRC风险增加相关（HR 1.11；95% CI，1.04 - 1.18；趋势P值 = 0.004）。收入下降（即收入四分位数下降≥25%）也与CRC风险增加相关（HR 1.10；95% CI，1.05 - 1.16；趋势P值 = 0.001）。相比之下，持续高收入（即收入最高四分位数）与CRC风险降低相关（HR 0.81；95% CI，0.73 - 0.89；趋势P值 < 0.0001），这在直肠癌（HR 0.64；95% CI，0.53 - 0.78）和远端结肠癌（HR 0.70；95% CI，0.57 - 0.86）中更为明显。