Afghani Elham, Lau Bryan, Becker Laura K, Goggins Michael, Klein Alison P
Division of Gastroenterology, Department of Medicine, The Johns Hopkins Medical Institutions, Baltimore, MD, USA.
Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA.
BMJ Open. 2025 May 26;15(5):e099488. doi: 10.1136/bmjopen-2025-099488.
Pancreatic cancer diagnoses are frequently preceded by a new diabetes diagnosis. Screening individuals newly diagnosed with diabetes could enable the earlier detection of pancreatic cancer. We sought to estimate the risk of pancreatic cancer by age, sex, race and time since diabetes diagnosis.
Claims-based cohort study.
Johns Hopkins Medicine conducted this deidentified claims-based cohort study using the Optum Labs Data Warehouse.
Insurance enrollees from 1/2008-9/2018 were identified as non-diabetic or newly diagnosed diabetic. Our risk set included 4 732 313 individuals (424 129 newly diabetic) in 5 844 934 enrolment periods.
Time to pancreatic cancer. Diabetes and cancer were defined using (ICD)-9/10 codes.
Individuals with newly diagnosed diabetes were at an increased HR of pancreatic cancer, but this effect waned over time. The HR of pancreatic cancer following a diabetes diagnosis was higher in younger individuals and varied by race (lower HR in non-White individuals) (p<0.01, main effects and interactions). Thus, the probability of pancreatic cancer following a diabetes diagnosis was dependent on age, race and sex. For example, the 1-year probability of pancreatic cancer in a White male aged 75 was 0.45% (95%CI 0.41% to 0.49%) if they were newly diagnosed with diabetes and 0.090% (95%CI 0.084% to 0.096%) if they were free of diabetes. In contrast, the risk was lower at 0.15% (new-diabetic, 95% CI 0.13% to 0.16%) and 0.022% (diabetes free, 95%CI 0.020% to 0.023%) at age 55. The HR of pancreatic cancer for individuals with newly diagnosed diabetes compared with those free of diabetes was highest in the month following diagnosis (HR=14.7 and 9.6 for a 55 and 75 year old White male, respectively) but decreased in the following months, with a HR of 7.8 and 5.8 at 3 months, 5.6 and 4.1 at 6 months, and 3.9 and 2.8 at 1 year (p<0.01).
Consideration of the age-race-sex specific probability of pancreatic cancer and time since diabetes diagnosis is necessary when evaluating the risk of pancreatic cancer following a diabetes diagnosis.
胰腺癌诊断之前常常先有新发糖尿病的诊断。对新诊断为糖尿病的个体进行筛查有助于更早发现胰腺癌。我们试图按年龄、性别、种族以及糖尿病诊断后的时间来估算胰腺癌风险。
基于索赔数据的队列研究。
约翰霍普金斯医学中心利用Optum Labs数据仓库开展了这项去识别化的基于索赔数据的队列研究。
2008年1月至2018年9月的保险参保者被确定为非糖尿病患者或新诊断为糖尿病的患者。我们的风险队列包括5844934个参保期内的4732313名个体（424129名新诊断为糖尿病的患者）。
胰腺癌发病时间。糖尿病和癌症使用国际疾病分类（ICD）-9/10编码进行定义。
新诊断为糖尿病的个体患胰腺癌的风险比增加，但这种影响会随着时间减弱。糖尿病诊断后胰腺癌的风险比在较年轻个体中更高，且因种族而异（非白人个体风险比更低）（p<0.01，主效应及交互作用）。因此，糖尿病诊断后患胰腺癌的概率取决于年龄、种族和性别。例如，75岁白人男性新诊断为糖尿病时，1年内患胰腺癌的概率为0.45%（95%置信区间0.41%至0.49%），未患糖尿病时为0.090%（95%置信区间0.084%至0.096%）。相比之下，55岁时风险较低，新诊断为糖尿病时为0.15%（95%置信区间0.13%至0.16%），未患糖尿病时为0.022%（95%置信区间0.020%至0.023%）。新诊断为糖尿病的个体与未患糖尿病个体相比，患胰腺癌的风险比在诊断后的第一个月最高（55岁和75岁白人男性的风险比分别为14.7和9.6），但在随后几个月下降，3个月时风险比分别为7.8和5.8，6个月时为5.6和4.1，1年时为3.9和2.8（p<0.01）。
在评估糖尿病诊断后胰腺癌风险时，有必要考虑年龄、种族、性别特异性的胰腺癌概率以及糖尿病诊断后的时间。
