Yau Sarah Tsz Yui, Hung Chi Tim, Leung Eman Yee Man, Lee Albert, Yeoh Eng Kiong
JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR, China.
NPJ Prim Care Respir Med. 2025 Mar 30;35(1):20. doi: 10.1038/s41533-025-00417-x.
Past epidemiological studies demonstrated mixed findings on the association between diabetes and lung cancer. Given the possible links between diabetes, smoking, and respiratory diseases, this study aims to examine the interaction patterns among factors associated with the risk of lung cancer among diabetes patients. A territory-wide retrospective cohort study was performed using electronic health records of Hong Kong. Patients who received diabetes care in general outpatient clinics between 2010 and 2019 without cancer history were included and followed up until December 2019. Conditional inference survival tree was applied to examine the interaction patterns among factors associated with the risk of lung cancer. A total of 385,521 patients were included. During a median follow-up of 6.2 years, 3395 developed lung cancer. Age emerged as primary factor in differentiating the risk of lung cancer. Conditional on age ( ≤ 64 vs >64 years), smoking appeared as subsequent dominant risk factor within each subpopulation. Among old smokers aged >64 years characterized by long duration of diabetes (median: 6-8 years), chronic obstructive pulmonary disease (COPD) emerged as key risk factor. Six distinct subgroups of diabetes patients with different risk levels of lung cancer according to age, smoking, metformin use, and COPD status were identified. Findings of the study suggest the interaction patterns among age, smoking, and COPD on the risk of lung cancer among diabetes patients, providing targets for public health interventions.
以往的流行病学研究表明，糖尿病与肺癌之间的关联存在不同的研究结果。鉴于糖尿病、吸烟和呼吸系统疾病之间可能存在的联系，本研究旨在探讨糖尿病患者中与肺癌风险相关因素之间的相互作用模式。我们利用香港的电子健康记录进行了一项全地区范围的回顾性队列研究。纳入了2010年至2019年期间在普通门诊接受糖尿病治疗且无癌症病史的患者，并随访至2019年12月。应用条件推断生存树来研究与肺癌风险相关因素之间的相互作用模式。共纳入385,521名患者。在中位随访6.2年期间，3395人患肺癌。年龄是区分肺癌风险的主要因素。以年龄（≤64岁与>64岁）为条件，吸烟在每个亚组中成为随后的主要风险因素。在糖尿病病程长（中位：6 - 8年）的64岁以上老年吸烟者中，慢性阻塞性肺疾病（COPD）成为关键风险因素。根据年龄、吸烟、二甲双胍使用情况和COPD状态，确定了六个肺癌风险水平不同的糖尿病患者亚组。该研究结果表明了年龄、吸烟和COPD在糖尿病患者肺癌风险方面的相互作用模式，为公共卫生干预提供了目标。
