Association between type 2 diabetes and risk of cancer mortality: a pooled analysis of over 771,000 individuals in the Asia Cohort Consortium

Abstract

Aims/hypothesis: The aims of the study were to evaluate the association between type 2 diabetes and the risk of death from any cancer and specific cancers in East and South Asians.

Methods: Pooled analyses were conducted of 19 prospective population-based cohorts included in the Asia Cohort Consortium, comprising data from 658,611 East Asians and 112,686 South Asians. HRs were used to compare individuals with diabetes at baseline with those without diabetes for the risk of death from any cancer and from site-specific cancers, including cancers of the oesophagus, stomach, colorectum, colon, rectum, liver, bile duct, pancreas, lung, breast, endometrium, cervix, ovary, prostate, bladder, kidney and thyroid, as well as lymphoma and leukaemia.

Results: During a mean follow-up of 12.7 years, 37,343 cancer deaths (36,667 in East Asians and 676 in South Asians) were identified. Baseline diabetes status was statistically significantly associated with an increased risk of death from any cancer (HR 1.26; 95% CI 1.21, 1.31). Significant positive associations with diabetes were observed for cancers of the colorectum (HR 1.41; 95% CI 1.26, 1.57), liver (HR 2.05; 95% CI 1.77, 2.38), bile duct (HR 1.41; 95% CI 1.04, 1.92), gallbladder (HR 1.33; 95% CI 1.10, 1.61), pancreas (HR 1.53; 95% CI 1.32, 1.77), breast (HR 1.72; 95% CI 1.34, 2.19), endometrium (HR 2.73; 95% CI 1.53, 4.85), ovary (HR 1.60; 95% CI 1.06, 2.42), prostate (HR 1.41; 95% CI 1.09, 1.82), kidney (HR 1.84; 95% CI 1.28, 2.64) and thyroid (HR 1.99; 95% CI 1.03, 3.86), as well as lymphoma (HR 1.39; 95% CI 1.04, 1.86). Diabetes was not statistically significantly associated with the risk of death from leukaemia and cancers of the bladder, cervix, oesophagus, stomach and lung.

Conclusions/interpretation: Diabetes was associated with a 26% increased risk of death from any cancer in Asians. The pattern of associations with specific cancers suggests the need for better control (prevention, detection, management) of the growing epidemic of diabetes (as well as obesity), in order to reduce cancer mortality.

Keywords: Asia Cohort Consortium; Asians; Cancer mortality; Meta-analysis; Type 2 diabetes.

Fig. 1

Association between diabetes at baseline and site-specific cancer mortality in Asia by sex. HRs were adjusted for sex, baseline age, BMI, cigarette smoking, alcohol consumption, educational attainment and urban residence. ^aData were available only from the Seoul Male Cohort Study, Three-Prefecture Cohort Study Aichi, Japan Public Health Center-Based Prospective Study 1 and 2, Miyagi Cohort Study, Three-Prefecture Cohort Study Miyagi and Ohsaki National Health Insurance Beneficiaries Cohort Study. ^bResults are not shown among women because there were fewer than ten cancer deaths among participants with diabetes at baseline

Fig. 2

Subgroup analyses for the association between diabetes at baseline and mortality from any cancer, colorectal cancer, liver cancer, gallbladder cancer, pancreatic cancer and breast cancer. HRs were adjusted for sex, baseline age, BMI, cigarette smoking, alcohol consumption, educational attainment and urban residence. Results for breast cancer among ever smokers and ever drinkers are not presented because there were fewer than ten deaths among participants with diabetes at baseline. ^aAnalyses excluded people with missing information on history of cancer and data from the Seoul Male Cohort Study and Mumbai Cohort Study, which did not have data on previous diagnoses of cancer. ^bAnalyses excluded people with missing information on history of CVD or hypertension and data from the Mumbai Cohort Study