Finkle W D, McLaughlin J K, Rasgon S A, Yeoh H H, Low J E
Department of Research and Evaluation, Southern California Permanente Medical Group, Pasadena 91101.
Cancer Causes Control. 1993 Nov;4(6):555-8. doi: 10.1007/BF00052431.
Use of prescription diuretics and incidence of renal cell cancer have increased in the United States in the past 25 years. Recent interview-based epidemiologic studies have reported an association between diuretic use and renal cell cancer risk. Our study evaluated this hypothesis using, for the first time, medical records as the source of the information on prescription diuretic use. Using medical records of women from a prepaid health plan, we identified 191 cases and 191 controls matched on age, membership duration, and membership at diagnosis. Diuretics use and history of potential confounding factors were ascertained by a standardized review of the medical records of each subject, without reference to case or control status. There was a strong and statistically significant association between renal cell cancer and prescription diuretics (odds ratio [OR] adjusted for hypertension, smoking, and obesity = 2.9, 95 percent confidence interval [CI] = 1.7-4.7). Risk tended to increase with dose, measured by number of prescriptions. Since renal cancer can induce hypertension, which is treated by diuretics, and thereby confound the association with diuretics, we examined diuretic use 10 or more years prior to diagnosis when secondary hypertension would be unlikely. The OR for prescriptions 10 or more years before diagnosis was 3.5 (CI = 1.7-7.4). Our results support earlier reports of an excess risk of renal cell cancer among users of prescription diuretics and indicate need for further study to evaluate this relationship, especially due to the extensive use of diuretics and the increasing incidence of this cancer.
在过去25年中，美国处方利尿剂的使用和肾细胞癌的发病率均有所上升。最近基于访谈的流行病学研究报告了利尿剂使用与肾细胞癌风险之间的关联。我们的研究首次使用医疗记录作为处方利尿剂使用信息的来源，对这一假设进行了评估。利用一个预付健康计划中女性的医疗记录，我们确定了191例病例和191例对照，这些对照在年龄、参保时长和确诊时的参保情况方面与病例相匹配。通过对每个受试者的医疗记录进行标准化审查来确定利尿剂的使用情况和潜在混杂因素的病史，而不考虑病例或对照状态。肾细胞癌与处方利尿剂之间存在强烈且具有统计学意义的关联（经高血压、吸烟和肥胖调整后的优势比[OR]=2.9，95%置信区间[CI]=1.7 - 4.7）。风险倾向于随着以处方数量衡量的剂量增加而增加。由于肾癌可诱发高血压，而高血压可用利尿剂治疗，从而混淆与利尿剂的关联，我们在诊断前10年或更久（此时继发性高血压不太可能出现）时检查了利尿剂的使用情况。诊断前10年或更久的处方的OR为3.5（CI = 1.7 - 7.4）。我们的结果支持了早期关于处方利尿剂使用者中肾细胞癌风险增加的报告，并表明需要进一步研究来评估这种关系，特别是鉴于利尿剂的广泛使用以及这种癌症发病率的上升。
