Increased cancer burden in older adults with type 2 diabetes over past 20 years
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Cancer burden among older adults with type 2 diabetes has increased in the past 2 decades while all-cause mortality rates at all ages have decreased, according to a 20-year population-based study published in Diabetologia.
“While previous studies have extensively investigated inequalities in vascular outcomes among people with type 2 diabetes by sociodemographic factors, less is known about whether such inequalities exist in cancer mortality rates,” Suping Ling, BM, BA, PhD, assistant professor in epidemiology, department of noncommunicable disease epidemiology, faculty of epidemiology and population health at London School of Hygiene and Tropical Medicine, and colleagues wrote.
Researchers defined a cohort of 137,804 adults aged 35 years or older with newly diagnosed type 2 diabetes from the Clinical Practice Research Datalink between January 1998 and November 2018. Then, researchers evaluated trends in all-cause, all-cancer and cancer-specific mortality rates by age, sex, ethnicity, socioeconomic status, obesity and smoking status.
During a median follow-up of 8.4 years, all-cause mortality rates decreased for all ages between 1998 and 2018. In addition, cancer mortality rates decreased for individuals aged 55 and 65 years, with average annual percentage changes of –1.4% and –0.2%, respectively, but increased for individuals aged 75 and 85 years, with changes of 1.2% and 1.6%, respectively.
Researchers observed higher average annual percentage changes among women compared with men (1.5% vs. 0.5%), among individuals in the least deprived compared with the most deprived areas (1.5% vs. 1%) and among individuals with morbid obesity compared with those with normal weight (5.8% vs. 0.7%). However, these stratified subgroups experienced upward trends in cancer mortality rates. All white individuals and former/current smokers also experienced increasing cancer mortality rates while those in other ethnic groups and nonsmokers experienced downward cancer mortality trends.
Researchers also observed constant upward trends in mortality rates for pancreatic, liver and lung cancer for all ages, colorectal cancer for most ages, breast cancer for younger ages and prostate and endometrial cancer for older ages.
Adults with type 2 diabetes experienced more than a 1.5-fold increased risk for colorectal, pancreatic, liver and endometrial cancer mortality during the study period compared with the general population, the researchers wrote.
“Persistent inequalities in cancer mortality rates by sociodemographic factors and widening disparities by smoking status suggest that tailored cancer prevention and detection strategies are needed,” they wrote. “For example, some subgroups such as smokers experienced not only higher mortality rates, but also increasing mortality trends during the study period.”
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