Mortality Outcomes in People with Lung Cancer with and without Type2 Diabetes: A Cohort Study in England.

IF 3.4 2区医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Clinical Epidemiology Pub Date : 2025-07-17 eCollection Date: 2025-01-01 DOI:10.2147/CLEP.S498368

Eseosa Grace Igbinosa, Bodini Dharmasekara, Jennifer K Quint, Sanjay Popat, Krishnan Bhaskaran, Daniel Morganstein, Sarah Cook

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引用次数: 0

Abstract

Introduction: The impact of type 2 diabetes (T2DM) on mortality following lung cancer diagnosis remains unclear, with conflicting evidence across studies. We aimed to assess differences in all-cause and cause-specific mortality between people with lung cancer with and without T2DM within a primary care population in England.

Methods: The study population was 69,674 people with incident lung cancer within the Clinical Practice Research Datalink (CPRD) Aurum primary care database (2010-2022). The study exposure was T2DM at cancer diagnosis, and the outcomes were all-cause and cause-specific mortality (cancer, cardio-vascular, respiratory). Cox models were fitted for each outcome adjusting for age, gender, smoking status, body mass index, calendar year and socioeconomic status (Index of Multiple Deprivation).

Results: After adjusting for age and gender, there was no evidence for a difference in all-cause mortality in people with T2DM compared with people without T2DM (IRR 0.98 95% CI 0.96, 1.01). After fully-adjusting for measured confounders, there was a small positive effect (IRR 1.07 95% CI 1.04, 1.09). After adjusting for age and gender, people with T2DM had lower rates of cancer-specific mortality compared to people without T2DM (IRR 0.96 95% CI 0.94, 0.98). However, after adjustment for all measured confounders there was a small positive association (IRR 1.05 95% CI 1.02, 1.07). In both age and gender adjusted and fully adjusted models people with T2DM had higher cardiovascular (fully adjusted HR 1.30 95% CI 1.15, 1.47) and respiratory disease mortality (fully adjusted HR 1.30 95% CI 1.15, 1.47).

Conclusion: There was robust evidence that people with T2DM had higher cardiovascular and respiratory disease mortality following lung cancer diagnosis. The relationships between T2DM and all-cause and cancer-specific mortality were highly sensitive to adjustment for confounding. Differences in studies on approaches to confounding and levels of missing data may contribute to the mixed findings on this association in the literature.

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肺癌合并和不合并2型糖尿病患者的死亡率结局：英国的一项队列研究

2型糖尿病（T2DM）对肺癌诊断后死亡率的影响尚不清楚，各研究的证据相互矛盾。我们的目的是评估英国初级保健人群中合并和不合并2型糖尿病的肺癌患者的全因死亡率和病因特异性死亡率的差异。方法：研究人群为临床实践研究数据链（CPRD） Aurum初级保健数据库（2010-2022）中的69,674例肺癌患者。研究暴露于癌症诊断时为2型糖尿病，结果为全因死亡率和病因特异性死亡率（癌症、心血管、呼吸系统）。对每个结果进行Cox模型拟合，校正了年龄、性别、吸烟状况、体重指数、日历年和社会经济地位（多重剥夺指数）。结果：在调整年龄和性别后，没有证据表明T2DM患者与非T2DM患者的全因死亡率有差异（IRR 0.98 95% CI 0.96, 1.01）。在对测量的混杂因素进行充分调整后，有一个小的正效应（IRR 1.07 95% CI 1.04, 1.09）。在调整了年龄和性别后，T2DM患者的癌症特异性死亡率低于非T2DM患者（IRR 0.96 95% CI 0.94, 0.98）。然而，在对所有测量的混杂因素进行校正后，有一个小的正相关（IRR 1.05 95% CI 1.02, 1.07）。在年龄和性别调整和完全调整模型中，T2DM患者的心血管疾病（完全调整HR 1.30 95% CI 1.15, 1.47）和呼吸系统疾病死亡率均较高（完全调整HR 1.30 95% CI 1.15, 1.47）。结论：有强有力的证据表明，T2DM患者在肺癌诊断后心血管和呼吸系统疾病死亡率更高。T2DM与全因死亡率和癌症特异性死亡率之间的关系对校正混杂因素高度敏感。在混淆方法和缺失数据水平方面的研究差异可能导致文献中对这种关联的不同发现。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical Epidemiology Medicine-Epidemiology

CiteScore

6.30

自引率

5.10%

发文量

169

审稿时长

16 weeks

期刊介绍： Clinical Epidemiology is an international, peer reviewed, open access journal. Clinical Epidemiology focuses on the application of epidemiological principles and questions relating to patients and clinical care in terms of prevention, diagnosis, prognosis, and treatment. Clinical Epidemiology welcomes papers covering these topics in form of original research and systematic reviews. Clinical Epidemiology has a special interest in international electronic medical patient records and other routine health care data, especially as applied to safety of medical interventions, clinical utility of diagnostic procedures, understanding short- and long-term clinical course of diseases, clinical epidemiological and biostatistical methods, and systematic reviews. When considering submission of a paper utilizing publicly-available data, authors should ensure that such studies add significantly to the body of knowledge and that they use appropriate validated methods for identifying health outcomes. The journal has launched special series describing existing data sources for clinical epidemiology, international health care systems and validation studies of algorithms based on databases and registries.