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. 2025 Apr 29:11:e62756.
doi: 10.2196/62756.

Survival Tree Analysis of Interactions Among Factors Associated With Colorectal Cancer Risk in Patients With Type 2 Diabetes: Retrospective Cohort Study

Sarah Tsz Yui Yau  1 , Chi Tim Hung  1 , Eman Yee Man Leung  1 , Albert Lee  1 , Eng Kiong Yeoh  1
Affiliations

Survival Tree Analysis of Interactions Among Factors Associated With Colorectal Cancer Risk in Patients With Type 2 Diabetes: Retrospective Cohort Study

Sarah Tsz Yui Yau et al. JMIR Public Health Surveill. .

Abstract

Background: Colorectal cancer (CRC) and diabetes share many common lifestyle risk factors, such as obesity. However, it remains largely unknown how different factors interact to influence the risk of CRC development among patients with diabetes.

Objective: This study aimed to identify the interaction patterns among factors associated with the risk of CRC incidence among patients with diabetes.

Methods: This is a retrospective cohort study conducted using electronic health records from Hong Kong. Patients who were diagnosed with type 2 diabetes and received care in general outpatient clinics between 2010 and 2019 without cancer history were included and followed up until December 2019. A conditional inference survival tree was applied to examine the interaction patterns among factors associated with the risk of CRC.

Results: A total of 386,325 patients were included. During a median follow-up of 6.2 years (IQR 3.3-8.0), 4199 patients developed CRC. Patients were first partitioned into 4 age groups by increased levels of CRC risk (≤54 vs 55 to 61 vs 62 to 73 vs >73 years). Among patients aged more than 54 years, male sex was the dominant risk factor for CRC within each age stratum and the associations lessened with age. Abdominal obesity (waist-to-hip ratio >0.95) and longer duration of diabetes (median 12, IQR 7-18 vs median 4, IQR 1-11 years) were identified as key risk factor for CRC among men aged between 62 and 73 years and women aged more than 73 years, respectively.

Conclusions: This study suggests the interaction patterns among age, sex, waist-to-hip ratio, and duration of diabetes on the risk of CRC incidence among patients with diabetes. Findings of the study may help identify target groups for public health intervention strategies.

Keywords: colorectal cancer; decision tree; interaction; public health; recursive partitioning; risk factor; risk stratification; segmentation; survival analysis; type 2 diabetes.

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Conflict of interest statement

Conflicts of Interest: None declared.

Figures

Figure 1.
Figure 1.. Flowchart of patient selection.
Figure 2.
Figure 2.. Survival tree diagram illustrating the interaction patterns among key factors on colorectal cancer incidence among patients with diabetes.
Figure 3.
Figure 3.. Kaplan–Meier curves for colorectal cancer-free survival across distinct subgroups of patients with diabetes.
See this image and copyright information in PMC

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