Igbinosa Eseosa Grace, Dharmasekara Bodini, Quint Jennifer K, Popat Sanjay, Bhaskaran Krishnan, Morganstein Daniel, Cook Sarah
School of Public Health, Imperial College London, London, UK.
School of Computer Science and Mathematics, Keele University, Staffordshire, UK.
Clin Epidemiol. 2025 Jul 17;17:681-692. doi: 10.2147/CLEP.S498368. eCollection 2025.
The impact of type 2 diabetes (T2DM) on mortality following lung cancer diagnosis remains unclear, with conflicting evidence across studies. We aimed to assess differences in all-cause and cause-specific mortality between people with lung cancer with and without T2DM within a primary care population in England.
The study population was 69,674 people with incident lung cancer within the Clinical Practice Research Datalink (CPRD) Aurum primary care database (2010-2022). The study exposure was T2DM at cancer diagnosis, and the outcomes were all-cause and cause-specific mortality (cancer, cardio-vascular, respiratory). Cox models were fitted for each outcome adjusting for age, gender, smoking status, body mass index, calendar year and socioeconomic status (Index of Multiple Deprivation).
After adjusting for age and gender, there was no evidence for a difference in all-cause mortality in people with T2DM compared with people without T2DM (IRR 0.98 95% CI 0.96, 1.01). After fully-adjusting for measured confounders, there was a small positive effect (IRR 1.07 95% CI 1.04, 1.09). After adjusting for age and gender, people with T2DM had lower rates of cancer-specific mortality compared to people without T2DM (IRR 0.96 95% CI 0.94, 0.98). However, after adjustment for all measured confounders there was a small positive association (IRR 1.05 95% CI 1.02, 1.07). In both age and gender adjusted and fully adjusted models people with T2DM had higher cardiovascular (fully adjusted HR 1.30 95% CI 1.15, 1.47) and respiratory disease mortality (fully adjusted HR 1.30 95% CI 1.15, 1.47).
There was robust evidence that people with T2DM had higher cardiovascular and respiratory disease mortality following lung cancer diagnosis. The relationships between T2DM and all-cause and cancer-specific mortality were highly sensitive to adjustment for confounding. Differences in studies on approaches to confounding and levels of missing data may contribute to the mixed findings on this association in the literature.
2型糖尿病（T2DM）对肺癌诊断后死亡率的影响仍不明确，各项研究证据相互矛盾。我们旨在评估英国基层医疗人群中患肺癌且伴有和不伴有T2DM者在全因死亡率和特定病因死亡率方面的差异。
研究人群为临床实践研究数据链（CPRD）奥鲁姆基层医疗数据库（2010 - 2022年）中69674例新发肺癌患者。研究暴露因素为癌症诊断时的T2DM，结局指标为全因死亡率和特定病因死亡率（癌症、心血管疾病、呼吸系统疾病）。针对每个结局指标拟合Cox模型，对年龄、性别、吸烟状况、体重指数、日历年份和社会经济状况（多重剥夺指数）进行调整。
在对年龄和性别进行调整后，与未患T2DM者相比，患T2DM者在全因死亡率方面没有差异的证据（风险比0.98，95%置信区间0.96，1.01）。在对测量到的混杂因素进行完全调整后，有一个小的正向效应（风险比1.07，95%置信区间1.04，1.09）。在对年龄和性别进行调整后，与未患T2DM者相比，患T2DM者的癌症特异性死亡率较低（风险比0.96，95%置信区间0.94，0.98）。然而，在对所有测量到的混杂因素进行调整后，有一个小的正向关联（风险比1.05，95%置信区间1.02，1.07）。在年龄和性别调整模型以及完全调整模型中，患T2DM者的心血管疾病死亡率（完全调整后的风险比1.30，95%置信区间1.15，1.47）和呼吸系统疾病死亡率（完全调整后的风险比1.30，95%置信区间1.15，1.47）均较高。
有充分证据表明，患T2DM者在肺癌诊断后心血管疾病和呼吸系统疾病死亡率较高。T2DM与全因死亡率和癌症特异性死亡率之间的关系对混杂因素调整高度敏感。关于混杂因素处理方法和缺失数据水平的研究差异可能导致文献中关于此关联的研究结果不一。
