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Impact of diabetes and modifiable risk factors on pancreatic cancer survival in a population-based study after adjusting for clinical factors



Our study aimed to examine the impact of diabetes, smoking and BMI on pancreatic cancer survival in a population-based setting by adjusting both sociodemographic and clinical factors and measuring their attributable risk.


Data on pancreatic adenocarcinoma patients diagnosed in 2011–2017 were acquired from the Louisiana Tumor Registry. Diabetes, smoking, height, and weight were abstracted from medical records and linked with Hospital Inpatient Discharge Data to enhance the completeness of the diabetes data. The Cox regression model was used to assess effect sizes of diabetes, smoking, and BMI on cancer-specific survival and survival rate. The partial population attributable risk was employed to measure the attributable risk of these risk factors.


Of the 3,200 eligible patients, 34.6% were diabetics, 23.9% were current smokers, and 52.3% had BMI ≥ 25 kg/m2. After adjusting for sociodemographic and clinical factors, diabetic patients had an increased cancer-specific death risk of 15% (95% CI, 1.06–1.25), 36% (95% CI, 1.19–1.44) for current smokers, and 24% (95% CI, 1.00–1.54) for patients with a BMI ≥ 40 when compared to their counterparts. Diabetic current smokers had significantly lower 2- and 3-year adjusted cancer-specific survival rates, 13.1% and 10.5%, respectively. By eliminating diabetes and modifiable risk factors, an estimated 16.6% (95% CI, 6.9%–25.9%) of the cancer-specific deaths could be avoided during a nine-year observational period between 2011 and 2019.


Diabetes and smoking contributed substantially to the reduction of pancreatic cancer survival even after controlling for sociodemographic and clinical factors; however, BMI ≥ 35 was observed to increase risk of mortality among stage III–IV patients only.

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Data availability

The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.


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This work was supported in part by Louisiana State University Health Sciences Center, the Centers for Disease Control and Prevention under cooperative agreement of the National Program of Cancer Registries Grant Number NU58DP006332, and the National Cancer Institute’s Contract Number HHSN2612018000071.

Author information




M-CH and LZ devised the project and the main conceptual ideas and performed literature review. M-CH and CV-G conducted statistical plan, analyzed the data, and verified the analytical methods. YY performed data inquiry and data linkage. LP performed data collection and quality assessment. M-CH the lead in writing the initial manuscript. X-CW, VC, and ET provided specifically critical review, commentary, and revision. All authors contributed to review and edit the final version of manuscript.

Corresponding author

Correspondence to Mei-Chin Hsieh.

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Conflict of interest

The authors declare no potential conflicts of interest.

Ethical approval

We received institutional review board (IRB) approval from the Louisiana State University Health Sciences Center—New Orleans to use Louisiana Tumor Registry data for this study.

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Hsieh, MC., Zhang, L., Velasco-Gonzalez, C. et al. Impact of diabetes and modifiable risk factors on pancreatic cancer survival in a population-based study after adjusting for clinical factors. Cancer Causes Control (2021).

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  • Pancreatic adenocarcinoma
  • Pancreatic cancer
  • Cancer-specific survival
  • Diabetes
  • Smoking status
  • BMI