Associations between metabolic disorders and risk of cancer in Danish men and women – a nationwide cohort study

Abstract

BackgroundThe prevalence of metabolic disorders is increasing and has been suggested to increase cancer risk, but the relation between metabolic disorders and risk of cancer is unclear, especially in young adults. We investigated the associations between diabetes, hypertension, and hypercholesterolemia on risk of all-site as well as site-specific cancers.MethodsWe consecutively included men and women from nationwide Danish registries 1996–2011, if age 20–89 and without cancer prior to date of entry. We followed them throughout 2012. Metabolic disorders were defined using discharge diagnosis codes and claimed prescriptions. We used time-dependent sex-stratified Poisson regression models adjusted for age and calendar year to assess associations between metabolic disorders, and risk of all-site and site-specific cancer (no metabolic disorders as reference).ResultsOver a mean follow-up of 12.6 (±5.7 standard deviations [SD]) years, 4,826,142 individuals (50.2 % women) with a mean age of 41.4 (±18.9 SD) years had 423,942 incident cancers. Incidence rate ratios (IRRs) of all-site cancer in patients with diabetes or hypertension were highest immediately following diagnosis of metabolic disorder. In women, cancer risk associated with diabetes continued to decline albeit remained significant (IRRs of 1.18–1.22 in years 1–8 following diagnosis). For diabetes in men, and hypertension, IRRs stabilized and remained significantly increased after about one year with IRRs of 1.10-1.13 in men for diabetes, and 1.07–1.14 for hypertension in both sexes. Conversely, no association was observed between hypercholesterolemia (treatment with statins) and cancer risk. The association between hypertension and cancer risk was strongest in young adults aged 20–34 and decreased with advancing age.ConclusionsDiabetes and hypertension were associated with increased risk of all-site cancer.Electronic supplementary materialThe online version of this article (doi:10.1186/s12885-016-2122-7) contains supplementary material, which is available to authorized users.

Incidence of new onset cancer in patients with a myocardial infarction – a nationwide cohort study

“…In accordance with our hypothesis, increased risk of cancer in MI patients could be confounded by shared risk factors or comorbidities that are markers of risk factors [ 24 ]. We, therefore, conducted sensitivity analyses, in which we adjusted for dyslipidemia, hypertension, diabetes mellitus, chronic obstructive pulmonary disease and socioeconomic status.…”

Perspectives on diabetes mortality as the result of residual confounding and reverse causality by common disease

“…This was consistent over all treatment regimens. This association was also shown in a subsequent study that looked at the risk of cancer in relation to diabetes duration, as well as other metabolic diseases …”

“…As a final digression, one of the studies discussed in this paper showed a temporal relationship between hypertension and cancer similar to that between diabetes and cancer; that is, the risk of being diagnosed with cancer was highest just after being diagnosed with or upon initiating treatment for hypertension. Another study showed that the risk of being diagnosed with cancer in type 1 diabetes patients was highest in those with a shorter duration of diabetes .…”

Sex differences in the association between diabetes and cancer: a systematic review and meta-analysis of 121 cohorts including 20 million individuals and one million events

“…with diabetes (% women) Type of diabetes Ascertainment of diabetes No. with outcome (% women) I or M Maximum adjustment available Ragozzino et al [ 21 ] USA 1945–1969 8.6 1135 (NR) NR 1135 (NR) Both Measured 120 (47) I Age Sasazuki et al [ 22 ] Japan (8 cohorts) 1984–1994 9.9 339,459 (54) 35–103 NR Both Self-reported 33,022 (40) I Age, area, Hx of cerebrovascular disease, CHD, smoking, alcohol consumption, BMI, physical exercise, green leafy vegetable consumption, coffee intake Gini et al [ 23 ] Italy 2002–2009 3.7 32,247 (45) 65 32,247 (45) T2 Hospital discharge diagnosis, exemption from medical charges, prescription 2069 (37) I Age, year at cancer diagnosis Berger et al [ 24 ] Denmark 1996–2011 12.6 4,826,142 (50) 41.4 65,690 (47) Both Discharge diagnosis, claimed prescription 423,942 (51) I Age Carstensen et al [ 25 ] Australia, Denmark, Finland, Scotland, Sweden 1987–2000 8–38 NR 3,932,900 person-years (50) NR NR T1 Diabetes registry, impatient dataset 9149 (56) I Age, date of follow-up, date of birth Diabetes II-to-Cancer [ 26 ] Germany 2003 3.3 26,742 (53) 64 26,742 (53) T2 Physician’s diagnosis …”