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- Title
Type 2 Diabetes and Colorectal Cancer Risk.
- Authors
Lawler, Thomas; Walts, Zoe L.; Steinwandel, Mark; Lipworth, Loren; Murff, Harvey J.; Zheng, Wei; Warren Andersen, Shaneda
- Abstract
This cohort study evaluates the association of diabetes with colorectal cancer risk in an African American, low-income population. Key Points: Question: What is the association of diabetes with colorectal cancer (CRC) risk in an African American, low-income population? Findings: In this cohort study of 54 597 adults, a diabetes diagnosis was associated with a 47% increased risk of developing CRC compared with participants without a diabetes diagnosis. This association was greater for participants without recent colonoscopy screenings and participants with a more recent diabetes diagnosis. Meaning: These findings suggest that given the emerging association between diabetes and elevated risk for colorectal cancer, screening via colonoscopy for individuals with diabetes may help to mitigate risk. Importance: Type 2 diabetes and colorectal cancer (CRC) disproportionately burden indviduals of low socioeconomic status and African American race. Although diabetes is an emerging CRC risk factor, associations between diabetes and CRC in these populations are understudied. Objective: To determine if diabetes is associated with CRC risk in a cohort representing understudied populations. Design, Setting, and Participants: This cohort study uses data from the prospective Southern Community Cohort Study in the US, which recruited from 2002 to 2009 and completed 3 follow-up surveys by 2018. Of about 85 000 participants, 86% enrolled at community health centers, while 14% were enrolled via mail or telephone from the same 12 recruitment states. Participants with less than 2 years of follow-up, previous cancer diagnosis (excluding nonmelanoma skin cancer) at enrollment, missing enrollment diabetes status, diabetes diagnosis before age 30, and without diabetes at enrollment with no follow-up participation were excluded. Data were analyzed from January to September 2023. Exposures: Physician-diagnosed diabetes and age at diabetes diagnosis were self-reported via survey at enrollment and 3 follow-ups. Main Outcomes and Measures: Diabetes diagnosis was hypothesized to be positively associated with CRC risk before analysis. Incident CRC was assessed via state cancer registry and National Death Index linkage. Hazard ratios and 95% CIs were obtained via Cox proportional hazard models, using time-varying diabetes exposure. Results: Among 54 597 participants, the median (IQR) enrollment age was 51 (46-58) years, 34 786 (64%) were female, 36 170 (66%) were African American, and 28 792 (53%) had income less than $15 000 per year. In total, 289 of 25 992 participants with diabetes developed CRC, vs 197 of 28 605 participants without diabetes. Diabetes was associated with increased CRC risk (hazard ratio [HR], 1.47; 95% CI, 1.21-1.79). Greater associations were observed among participants without colonoscopy screening (HR, 2.07; 95% CI, 1.16-3.67) and with smoking history (HR, 1.62; 95% CI, 1.14-2.31), potentially due to cancer screening differences. Greater associations were also observed for participants with recent diabetes diagnoses (diabetes duration <5 years compared with 5-10 years; HR, 2.55; 95% CI, 1.77-3.67), possibly due to recent screening. Conclusions and Relevance: In this study where the majority of participants were African American with low socioeconomic status, diabetes was associated with elevated CRC risk, suggesting that diabetes prevention and control may reduce CRC disparities. The association was attenuated for those who completed colonoscopies, highlighting how adverse effects of diabetes-related metabolic dysregulation may be disrupted by preventative screening.
- Subjects
DIABETES prevention; REPORTING of diseases; CONFIDENCE intervals; COLONOSCOPY; AGE distribution; SELF-evaluation; EARLY detection of cancer; TYPE 2 diabetes; COLORECTAL cancer; INCOME; SOCIOECONOMIC status; DESCRIPTIVE statistics; DISEASE duration; SOCIAL classes; QUESTIONNAIRES; MEDICAL records; RESEARCH funding; SMOKING; SENSITIVITY &; specificity (Statistics); LONGITUDINAL method; PROPORTIONAL hazards models; AFRICAN Americans; DISEASE risk factors; DISEASE complications
- Publication
JAMA Network Open, 2023, Vol 6, Issue 11, pe2343333
- ISSN
2574-3805
- Publication type
Article
- DOI
10.1001/jamanetworkopen.2023.43333