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. 2025 Jul 17:17:681-692.
doi: 10.2147/CLEP.S498368. eCollection 2025.

Mortality Outcomes in People with Lung Cancer with and without Type2 Diabetes: A Cohort Study in England

Eseosa Grace Igbinosa  1   2 , Bodini Dharmasekara  1 , Jennifer K Quint  1 , Sanjay Popat  3 , Krishnan Bhaskaran  4 , Daniel Morganstein  3   5 , Sarah Cook  1
Affiliations

Mortality Outcomes in People with Lung Cancer with and without Type2 Diabetes: A Cohort Study in England

Eseosa Grace Igbinosa et al. Clin Epidemiol. .

Abstract

Introduction: The impact of type 2 diabetes (T2DM) on mortality following lung cancer diagnosis remains unclear, with conflicting evidence across studies. We aimed to assess differences in all-cause and cause-specific mortality between people with lung cancer with and without T2DM within a primary care population in England.

Methods: The study population was 69,674 people with incident lung cancer within the Clinical Practice Research Datalink (CPRD) Aurum primary care database (2010-2022). The study exposure was T2DM at cancer diagnosis, and the outcomes were all-cause and cause-specific mortality (cancer, cardio-vascular, respiratory). Cox models were fitted for each outcome adjusting for age, gender, smoking status, body mass index, calendar year and socioeconomic status (Index of Multiple Deprivation).

Results: After adjusting for age and gender, there was no evidence for a difference in all-cause mortality in people with T2DM compared with people without T2DM (IRR 0.98 95% CI 0.96, 1.01). After fully-adjusting for measured confounders, there was a small positive effect (IRR 1.07 95% CI 1.04, 1.09). After adjusting for age and gender, people with T2DM had lower rates of cancer-specific mortality compared to people without T2DM (IRR 0.96 95% CI 0.94, 0.98). However, after adjustment for all measured confounders there was a small positive association (IRR 1.05 95% CI 1.02, 1.07). In both age and gender adjusted and fully adjusted models people with T2DM had higher cardiovascular (fully adjusted HR 1.30 95% CI 1.15, 1.47) and respiratory disease mortality (fully adjusted HR 1.30 95% CI 1.15, 1.47).

Conclusion: There was robust evidence that people with T2DM had higher cardiovascular and respiratory disease mortality following lung cancer diagnosis. The relationships between T2DM and all-cause and cancer-specific mortality were highly sensitive to adjustment for confounding. Differences in studies on approaches to confounding and levels of missing data may contribute to the mixed findings on this association in the literature.

Keywords: cardiovascular mortality; lung cancer; mortality; respiratory mortality; type 2 diabetes.

Plain language summary

Lung cancer and type 2 diabetes are both common conditions that have a big impact on health outcomes worldwide. There is some evidence that people with type 2 diabetes have a higher chance of dying if they develop certain cancers than people without type 2 diabetes. It is not clear if having type 2 diabetes affects people’s chances of dying if they develop lung cancer, or if any increased risk of death is due to lung cancer or other conditions such as heart disease. We used data from general practice records linked with hospital and death records from England to investigate whether people with diabetes were more or less likely to die following being diagnosed with lung cancer overall and from three specific causes of death: cancer, heart disease and lung disease. People with type 2 diabetes were more likely to die from heart disease and lung-related illnesses after being diagnosed with lung cancer than people without type 2 diabetes. However, differences in dying overall and of dying from cancer were small and depended on how other factors, like age and smoking, were considered. These findings highlight the importance of managing heart and lung health in people living with type 2 diabetes who are diagnosed with lung cancer.

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Conflict of interest statement

Jennifer Quint reports grants from HDR UK, during the conduct of the study; Sanjay Popat reports personal fees from Anheart Therapeutics, Amgen, AstraZeneca, Bayer, Arcus Biosciences, BMS, Boehringer Ingelheim, Ellipses, EQRx, Daiichi Sankyo, Gilead, GSK, Guardant Health, IO Biotech, Janssen, Lilly, Merck Serono, Mirati, MSD, Novocure, Novartis, Pharmamar, Roche, Takeda, Pfizer, Pierre Fabre, Turning Point Therapeutics, Regeneron, outside the submitted work; Krishnan Bhaskaran reports grants from Wellcome, during the conduct of the study; Daniel Morganstein reports personal fees from BMS and Pfizer, outside the submitted work; Sarah Cook reports grants from NIHR, outside the submitted work. The other authors report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
Exclusion criteria for patients included in the analysis, Reasons for ineligibility with the number of participants excluded.
See this image and copyright information in PMC

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References

    1. Joharatnam-Hogan N, Chambers P, Dhatariya K, Board R. A guideline for the outpatient management of glycaemic control in people with cancer. Diabet Med. 2022;39(1):e14636. doi: 10.1111/dme.14636 - DOI - PubMed
    1. Bjornsdottir HH, Rawshani A, Rawshani A, et al. A national observation study of cancer incidence and mortality risks in type 2 diabetes compared to the background population over time. Sci Rep. 2020;10(1):17376. doi: 10.1038/s41598-020-73668-y - DOI - PMC - PubMed
    1. Barone BB, Yeh HC, Snyder CF, et al. Long-term all-cause mortality in cancer patients with preexisting diabetes mellitus: a systematic review and meta-analysis. JAMA. 2008;300(23):2754–2764. doi: 10.1001/jama.2008.824 - DOI - PMC - PubMed
    1. Barua R, Templeton AJ, Seruga B, Ocana A, Amir E, Ethier JL. Hyperglycaemia and survival in solid tumours: a systematic review and meta-analysis. Clin Oncol. 2018;30(4):215–224. doi: 10.1016/j.clon.2018.01.003 - DOI - PubMed
    1. Tao H, O’Neil A, Choi Y, et al. Pre- and post-diagnosis diabetes as a risk factor for all-cause and cancer-specific mortality in breast, prostate, and colorectal cancer survivors: a prospective cohort study. Front Endocrinol. 2020;11:60. doi: 10.3389/fendo.2020.00060 - DOI - PMC - PubMed

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