Inequalities in cancer mortality trends in people with type 2 diabetes: 20 year population-based study in England
Authors' conclusion
In contrast to the declines in all-cause mortality rates at all ages, the cancer burden has increased in older people with type 2 diabetes, especially for colorectal, pancreatic, liver and endometrial cancer. Tailored cancer prevention and early detection strategies are needed to address persistent inequalities in the older population, the most deprived and smokers.
Study context
- Population
- Individuals aged ≥35 years with newly diagnosed T2D in the Clinical Practice Research Datalink, 1 January 1998 to 30 November 2018, Englandmedian follow-up 8.4 years
- Participants
- 137,804 individuals
- Outcome
- Trends in all-cause, all-cancer and cancer-specific mortality rates by age, gender, ethnicity, socioeconomic status, obesity and smoking status
- Follow-up
- 1998–2018
Methodological detailsPoisson regression, Joinpoint regression, standardised mortality ratios vs general population
- Poisson regression
- Joinpoint regression
- Standardised mortality ratios vs general population
Main finding
As reported in the abstract
Cancer mortality AAPC, 55-year-olds
−1.4%
95% CI −1.5, −1.3
Cancer mortality AAPC, 65-year-olds
−0.2%
−0.3, −0.1
Cancer mortality AAPC, 75-year-olds
1.2%
0.8, 1.6
Cancer mortality AAPC, 85-year-olds
1.6%
1.5, 1.7
Observational data: associations, not effects.
Further findings
Cancer mortality AAPC by subgroup
- Women vs men
- 1.5% vs 0.5%
- Least deprived vs most deprived
- 1.5% vs 1.0%
- Morbid obesity vs normal body weight
- 5.8% vs 0.7%
- All these stratified subgroups showed upward trends
- Increasing rates in White ethnicity and former/current smokers; downward trends in other ethnic groups and non-smokers
- Persistent inequalities by gender and deprivation; widening disparities by smoking status
Cancer-specific mortality trends
- Constant upward trends for pancreatic, liver and lung cancer at all ages, colorectal at most ages, breast at younger ages, prostate and endometrial at older ages
Cancer mortality vs general population · whole study period
- More than 1.5-fold increased risk of colorectal, pancreatic, liver and endometrial cancer mortality in T2D
Original publication
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