Diabetes but not insulin is associated with higher colon cancer mortality
Diabetes but not insulin is associated with higher colon cancer mortality
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DOI：
10.3748/wjg.v18.i31.4182
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发表时间：
2012-08-21
影响因子：
4.3
通讯作者：
Tseng, Chin-Hsiao
中科院分区：
文献类型：
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作者：
Tseng, Chin-Hsiao
目的：为了评估糖尿病患者是否有较高的风险结肠癌死亡率及其相关的危险factors.METHODS：性别特异性粗和年龄标准化（2000年世界卫生组织人口）的结肠癌死亡率在台湾一般人群中，首先计算1995年至2006年。通过线性回归评价趋势。从1995年到1998年，共有113 347名糖尿病男性和131 573名糖尿病女性，年龄在25岁以下，随访至2006年底。计算年龄/性别特异性结肠癌死亡率比，将糖尿病患者的死亡率与12年（1995-2006年）内一般人群的平均死亡率进行比较。一个子队列的糖尿病患者（42 260名男性和49 405名女性）进行了采访，使用基线问卷和考克斯的回归被用来评估结肠癌死亡率的危险因素，在这些糖尿病patients.RESULTS：原油和年龄标准化的趋势，结肠癌死亡率从1995年至2006年显着增加的性别在一般人群。共有641名男性糖尿病患者和573名女性糖尿病患者死于结肠癌，死亡率分别为74.4/10万人年和54.3/10万人年。死亡率比[95%置信区间（Cis）]显示，与一般人群相比，糖尿病患者的结肠癌死亡率风险显著更高，且随着年龄的降低，死亡率的幅度增加：1.65（1.40-1.95）、2.01（1.78-2.27）、2.75（2.36-3.21）和5.69年龄在75岁以上、65-74岁、55-64岁和25-54岁的男子分别为4.65-6.96;女性分别为1.46（1.24-1.72）、2.09（1.84-2.38）、2.67（2.27-3.14）和3.05（2.29-4.06）。在接受基线问卷调查的糖尿病患者子队列中，包括年龄、性别、糖尿病病程、糖尿病类型、体重指数、吸烟、胰岛素使用和居住地区等信息，年龄和吸烟对结肠癌死亡率有显著预测作用，校正后的风险比（HR）（95% CI）分别为1.077（1.066-1.088）和1.384（1.068-1.792）。当排除那些在糖尿病诊断后5年内死于结肠癌的人时，糖尿病病程成为一个重要因素，以最大限度地减少早期结肠癌引起的糖尿病污染，调整后的风险比为1.021（1.007-1.034）。性别、糖尿病类型、胰岛素使用、体重指数和居住地区不是糖尿病患者结肠癌死亡率的显著预测因素。虽然胰岛素的使用分为亚组的使用时间（非用户和用户< 5年，5-9年和>= 10年），没有HR结肠癌死亡率是显着的胰岛素使用不同的持续时间。结论：结肠癌死亡率在台湾正在增加。在糖尿病患者中观察到更高的风险。吸烟，而不是胰岛素使用，是一个可改变的风险因素。(C)2012年百世登。All rights reserved.
AIM: To evaluate whether diabetic patients had a higher risk of colon cancer mortality and its associated risk factors.METHODS: The sex-specific crude and age-standardized (to the 2000 World Health Organization population) mortality rates of colon cancer in the Taiwanese general population were first calculated from 1995 to 2006. The trends were evaluated by linear regression. A total of 113 347 diabetic men and 131 573 diabetic women aged 25 years at recruitment from 1995 to 1998 were followed up until the end of 2006. Age/sex-specific colon cancer mortality rate ratios were calculated comparing the mortality rates of the diabetic patients with the average mortality rates of the general population within 12 years (1995-2006). A sub-cohort of diabetic patients (42 260 men and 49 405 women) was interviewed using a baseline questionnaire and Cox's regression was used to evaluate the risk factors for colon cancer mortality in these diabetic patients.RESULTS: The crude and age-standardized trends of colon cancer mortality from 1995 to 2006 increased significantly for both sexes in the general population. A total of 641 diabetic men and 573 diabetic women died of colon cancer, with a mortality rate of 74.4 and 54.3 per 100 000 person-years, respectively. Mortality rate ratios [95% confidence intervals (Cis)] showed a significantly higher risk of mortality from colon cancer for the diabetic patients compared to the general population, with the magnitude increasing with decreasing age: 1.65 (1.40-1.95), 2.01 (1.78-2.27), 2.75 (2.36-3.21) and 5.69 (4.65-6.96) for >= 75, 65-74, 55-64 and 25-54 years old, respectively, for men; and 1.46 (1.24-1.72), 2.09 (1.84-2.38), 2.67 (2.27-3.14) and 3.05 (2.29-4.06), respectively, for women. Among the sub-cohort of diabetic patients who had been interviewed with the baseline questionnaire, including information on age, sex, diabetes duration, diabetes type, body mass index, smoking, insulin use and area of residence, age and smoking were significantly predictive for colon cancer mortality, with respective adjusted hazard ratios (HRs) (95% CIs) of 1.077 (1.066-1.088) and 1.384 (1.068-1.792). Diabetes duration became a significant factor when those who died of colon cancer within 5 years of diabetes diagnosis were excluded to minimize the possible contamination of diabetes caused by incipient colon cancer, with an adjusted hazard ratio of 1.021 (1.007-1.034). Sex, diabetes type, insulin use, body mass index and area of residence were not significant predictors for colon cancer mortality in the diabetic patients. Although insulin use was categorized into subgroups of duration of use (non-users and users < 5 years, 5-9 years and >= 10 years), none of the HRs for colon cancer mortality was significant with regards to different durations of insulin use.CONCLUSION: Colon cancer mortality is increasing in Taiwan. A higher risk is observed in diabetic patients. Smoking, but not insulin use, is a modifiable risk factor. (C) 2012 Baishideng. All rights reserved.