Purpose This study aimed to investigate the association between metformin usage and the risk of colorectal cancer (CRC) using data from the Korean National Health Insurance Service-National Health Screening Cohort database. Methods Data from the NHIS-HEALS cohort between 2002 and 2015 were longitudinally analyzed. Subjects were divided into three groups: metformin non-users with diabetes mellitus (DM), metformin users with DM, and no DM group. CRC was defined using the ICD-10 code (C18.0-C20.0) at the time of admission. Cox proportional hazard regression models were adopted after stepwise adjustment for confounders to investigate the association between metformin usage and colorectal cancer risk. Results During the follow-up period, of the total 323,430 participants, 2341 (1.33%) of the 175,495 males and 1204 (0.81%) of the 147,935 females were newly diagnosed with CRC. The estimated cumulative incidence of CRC was significantly different among the three groups based on Kaplan-Meier's survival curve (p values < 0.05 in both sexes). Compared with metformin nonusers, hazard ratios (95% CIs) of metformin users and the no DM group were 0.66 (0.51-0.85) and 0.72 (0.61-0.85) in males and 0.59 (0.37-0.92) and 0.93 (0.66-1.29) in females, respectively, after being fully adjusted. Conclusions Metformin users with diabetes appear to have a significantly lower risk of CRC compared with metformin nonusers.
Cohort between 2002 and 2015. Methods: Morphine milligram equivalent (MME) was calculated to standardize the relative potency of the opioids. The number (cases) or amount (MME) of annual opioid prescription per 10,000 registrants was computed to analyze trends of consumption of opioids after age standardization. Joinpoint regression analysis was conducted to calculate the annual percentage change and average annual percentage change (AAPC). Results: The number (cases) of prescriptions per 10,000 registrants increased from 0.07 in 2002 to 41.23 in 2015 (AAPC [95% CIs], 76.0% [61.6-91.7%]). The MME per 10,000 registrants increased from 15.06 in 2002 to 40,727.80 in 2015 (AAPC [95% CIs], 103.0% [78.2-131.3%]). The highest AAPC of prescriptions and MME per 10,000 registrants were observed in the elderly (60-69 years) and at general hospitals. Fentanyl prescription increased most rapidly among four opioids. Conclusions: Consumption of opioids greatly increased in South Korea over 14 years.
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