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Age at diagnosis modifies associations of type 2 diabetes with cancer incidence and mortality: a retrospective matched-cohort study

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Abstract

Aims/hypothesis

The age-specific associations between type 2 diabetes and cancer risk are not fully understood. The aim of this study was to assess how age at diagnosis modifies the associations between type 2 diabetes and cancer risk.

Methods

We used data from the Yinzhou Health Information System, and included 42,279 individuals who were newly diagnosed with type 2 diabetes between 2010 and 2014, as well as 166,010 age- and sex-matched control individuals without diabetes who were selected randomly from the electronic health records of the entire population. Patients were divided into four age groups according to age at diagnosis: <50, 50–59, 60–69 and ≥70 years. Stratified Cox proportional hazards regression models, with age as the time scale, were used to estimate the HRs and 95% CIs for the associations of type 2 diabetes with the risks of overall and site-specific cancers. Population-attributable fractions were also calculated for outcomes associated with type 2 diabetes.

Results

During median follow-up periods of 9.20 and 9.32 years, we identified 15,729 incident cancer cases and 5383 cancer deaths, respectively. Patients diagnosed with type 2 diabetes before 50 years of age had the highest relative risks of cancer incidence and mortality, with HRs (95% CI) of 1.35 (1.20, 1.52) for overall cancer incidence, 1.39 (1.11, 1.73) for gastrointestinal cancer incidence, 2.02 (1.50, 2.71) for overall cancer mortality, and 2.82 (1.91, 4.18) for gastrointestinal cancer mortality. Risk estimates decreased gradually with each decade increase in diagnostic age. The population-attributable fractions for overall cancer and gastrointestinal cancer mortality also decreased with increasing age.

Conclusions/interpretation

The associations of type 2 diabetes with cancer incidence and mortality varied by age at diagnosis, with a higher relative risk among patients who were diagnosed at a younger age.

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Data availability

The datasets generated during and/or analysed during the current study are not publicly available due to privacy protection for patients, but are available from the corresponding authors on reasonable request.

Funding

This work was supported by the National Natural Science Foundation of China (grant number 82173587) and the Ningbo Major Science and Technology Task Project (grant number 2021Z054).

Abbreviations

PAF:

Population-attributable fraction

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Acknowledgements

We would like to thank all staff of the Department of Chronic Disease and Health Promotion, Yinzhou District Center for Disease Control and Prevention, for data collection.

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Authors and Affiliations

  1. Department of Public Health, and Department of National Clinical Research Center for Child Health, The Children’s Hospital, Zhejiang University School of Medicine, Hangzhou, China

    Zongming Yang, Yonghao Wu, Lisha Xu, Tiezheng Li, Luhua Yu & Jianbing Wang

  2. Department of Public Health, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China

    Zhanghang Zhu, Kai Gao, Xinhan Zhang, Mingjuan Jin & Kun Chen

  3. Department of Chronic Disease and Health Promotion, Yinzhou District Center for Disease Control and Prevention, Ningbo, China

    Peng Shen & Hongbo Lin

  4. Yinzhou District Health Bureau of Ningbo, Ningbo, China

    Liming Shui

  5. Department of Public Health, Fourth Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China

    Mengling Tang

  6. Data Center, Yinzhou District Center for Disease Control and Prevention, Ningbo, China

    Yexiang Sun

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  1. Zongming Yang
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Correspondence to Yexiang Sun, Jianbing Wang or Kun Chen.

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The authors declare that there are no relationships or activities that might bias, or be perceived to bias, their work.

Contribution statement

ZY, YS, JW and KC contributed to the study concept and design. ZY, YW and LX drafted the manuscript. ZZ, TL, LY, KG and XZ performed data cleansing and statistical analysis. PS, HL, LS, MT and MJ supervised the study. All authors contributed to interpretation of the results and critical revision of the manuscript for important intellectual content, and approved the final version of the manuscript. YS, JW and KC are the guarantors of this work, and, as such, had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

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Yang, Z., Wu, Y., Xu, L. et al. Age at diagnosis modifies associations of type 2 diabetes with cancer incidence and mortality: a retrospective matched-cohort study. Diabetologia 66, 1450–1459 (2023). https://doi.org/10.1007/s00125-023-05920-9

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