Associations between diabetes and cancer: A 10-year national population-based retrospective cohort study

Heléna Safadi; Ágnes Balogh; Judit Lám; Attila Nagy; Éva Belicza

doi:10.1016/j.diabres.2024.111665

Associations between diabetes and cancer: A 10-year national population-based retrospective cohort study

Diabetes Res Clin Pract. 2024 May:211:111665. doi: 10.1016/j.diabres.2024.111665. Epub 2024 Apr 9.

Authors

Heléna Safadi¹, Ágnes Balogh², Judit Lám³, Attila Nagy⁴, Éva Belicza⁵

Affiliations

¹ Patient Safety Faculty Group, Health Service Management Training Centre, Semmelweis University, 2, Kútvölgyi Str., Budapest H-1125, Hungary; NEVES Society, 60, Tárogató Str., Budapest H-1021, Hungary. Electronic address: safadi.helena@emk.semmelweis.hu.
² Independent Statistician, Budapest, Hungary.
³ Patient Safety Faculty Group, Health Service Management Training Centre, Semmelweis University, 2, Kútvölgyi Str., Budapest H-1125, Hungary; NEVES Society, 60, Tárogató Str., Budapest H-1021, Hungary; Data-Driven Health Division of National Laboratory for Health Security, Health Services Management Training Centre, Semmelweis University, 2, Kútvölgyi Str., Budapest H-1125, Hungary. Electronic address: lam.judit@emk.semmelweis.hu.
⁴ Patient Safety Faculty Group, Health Service Management Training Centre, Semmelweis University, 2, Kútvölgyi Str., Budapest H-1125, Hungary; Department of Health Informatics, Institute of Health Informatics, Faculty of Health Sciences, University of Debrecen, 26, Kassai Str., Debrecen H-4028, Hungary. Electronic address: attilanagy@med.unideb.hu.
⁵ Patient Safety Faculty Group, Health Service Management Training Centre, Semmelweis University, 2, Kútvölgyi Str., Budapest H-1125, Hungary; NEVES Society, 60, Tárogató Str., Budapest H-1021, Hungary; Data-Driven Health Division of National Laboratory for Health Security, Health Services Management Training Centre, Semmelweis University, 2, Kútvölgyi Str., Budapest H-1125, Hungary. Electronic address: belicza.eva@emk.semmelweis.hu.

PMID: 38604444
DOI: 10.1016/j.diabres.2024.111665

Abstract

Aims: To investigate the risk of cancer in people with diabetes compared to the population without diabetes and to gain insight into the timely association between diabetes and cancer at national level.

Methods: A retrospective cohort study was conducted to analyse the role of diabetes in the development of cancer, based on service utilisation and antidiabetic dispensing data of the population between 2010 and 2021. Univariate and multivariate Cox regression were used to examine how diabetes status, in relationship with age and sex are related to the time to cancer diagnosis.

Results: Examining a population of 3 681 774 individuals, people with diabetes have a consistently higher risk for cancer diagnosis for each cancer site studied. Diabetes adds the highest risk for pancreatic cancer (HR = 2.294, 99 % CI: 2.099; 2.507) and for liver cancer (HR = 1.830, 99 % CI: 1.631; 2.054); it adds the lowest - but still significant - risk for breast cancer (HR = 1.137, 99 % CI: 1.055; 1.227) and prostate cancer (HR = 1.171, 99 % CI: 1.071; 1.280).The difference in cancer rate is driven by the younger age group (40-54 years: for patients with diabetes 5.4 % vs. controls 4.4 %; 70-89 years: for patients with diabetes 12.7 % vs. controls 12.4 %). There are no consistent results whether the presence of diabetes increases the risk of cancer diagnosis differently in males and females. The cancer incidence starts to increase before the diagnosis of diabetes and peaks in the year after. By the year after the start of the inclusion date, the incidence is 114/10,000 population in the control group, vs 195/10,000 population in the group with diabetes. Following this, the incidence drops close to the control group.

Conclusions: Screening activities should be revised and the guidelines on diabetes should be complemented with recommendations on cancer prevention also considering that the cancer incidence is highest around the time of the diagnosis of diabetes. For prostate cancer, our results contradict many previous studies, and further research is recommended to clarify this.

Keywords: Age; Cancer; Diabetes mellitus; Screening; Sex; Time to cancer.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adolescent
Adult
Aged
Aged, 80 and over
Cohort Studies
Diabetes Mellitus* / epidemiology
Female
Humans
Incidence
Male
Middle Aged
Neoplasms* / epidemiology
Retrospective Studies
Risk Factors
Young Adult