Cancer risk among patients hospitalized for Type 1 diabetes mellitus: a population-based cohort study in Sweden.
OBJECTIVE
Type 1 diabetes mellitus (T1DM) is an autoimmune disease with potential mechanistic links to immune-related cancers. We aimed at examining the overall and specific cancer risks among hospitalized T1DM patients from the national registers in Sweden.


METHODS
A T1DM research cohort was created by identifying T1DM patients from the Hospital Discharge Register and linking them with the Cancer Registry. Standardized incidence ratios (SIRs) for subsequent cancers were calculated among patients with T1DM compared with those without T1DM.


RESULTS
Two hundred and fifty-eight cases were ascertained with subsequent cancers during the follow-up duration from 1964 to 2006, with an increased overall SIR of 1.17 (95% CI 1.04-1.33) among 24 052 T1DM patients identified at baseline. Significant excess was noted for gastric and skin (squamous cell carcinoma) cancers and for leukaemia. Increased risk of acute lymphatic leukaemia accounted for most of the variation of leukaemia risk (SIR = 5.31, 95% CI 3.32-8.05). Cancer risk varied with sex, age at first hospitalization and numbers of hospitalizations. The risk was higher in women compared with men and in those hospitalized for T1DM at age over 10 years compared with the younger patients. Higher risks were also found among those with more hospital visits.


CONCLUSIONS
By quantifying the variations of overall and site-specific cancer risks after T1DM, the current study provides novel associations between T1DM and subsequent cancers, the mechanisms of which remain to be established.
Shu
X
X
Center for Family and Community Medicine, Karolinska Institute, Alfred Nobels allé 12, Huddinge, Sweden. xiaochen.shu@ki.se
Ji
J
J
Li
X
X
Sundquist
J
J
Sundquist
K
K
Hemminki
K
K
D000293:Adolescent; D017677:Age Distribution; D002294:Carcinoma, Squamous Cell / Q000453:epidemiology; D015331:Cohort Studies; D003922:Diabetes Mellitus, Type 1 / Q000150:complications* / Q000453:epidemiology; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D007938:Leukemia / Q000453:epidemiology; D008297:Male; D008498:Medical Record Linkage; D009369:Neoplasms / Q000150:complications / Q000453:epidemiology*; D012307:Risk Factors; D012878:Skin Neoplasms / Q000453:epidemiology; D013274:Stomach Neoplasms / Q000453:epidemiology; D013548:Sweden / Q000453:epidemiology