Associations of diabetes mellitus with site-specific cancer mortality in the Asia-Pacific region.
BACKGROUND
Owing to the increasing prevalence of obesity and diabetes in Asia, and the paucity of studies, we examined the influence of raised blood glucose and diabetes on cancer mortality risk.


METHODS
Thirty-six cohort Asian and Australasian studies provided 367, 361 participants (74% from Asia); 6% had diabetes at baseline. Associations between diabetes and site-specific cancer mortality were estimated using time-dependent Cox models, stratified by study and sex, and adjusted for age.


RESULTS
During a median follow-up of 4.0 years, there were 5992 deaths due to cancer (74% Asian; 41% female). Participants with diabetes had 23% greater risk of mortality from all-cause cancer compared with those without: hazard ratio (HR) 1.23 [95% confidence interval (CI) 1.12, 1.35]. Diabetes was associated with mortality due to cancer of the liver (HR 1.51; 95% CI 1.19, 1.91), pancreas (HR 1.78; 95% CI 1.20, 2.65), and, less strongly, colorectum (HR 1.32; 95% CI 0.98, 1.78). There was no evidence of sex- or region-specific differences in these associations. The population attributable fractions for cancer mortality due to diabetes were generally higher for Asia compared with non-Asian populations.


CONCLUSIONS
Diabetes is associated with increased mortality from selected cancers in Asian and non-Asian populations.
Lam
E K K
EKK
Department of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK; The George Institute for International Health, University of Sydney, Sydney, Australia; Department of Community Health and Epidemiology, School of Medicine, Queen's University, Kingston, Canada.
Batty
G D
GD
The George Institute for International Health, University of Sydney, Sydney, Australia; Medical Research Council Social & Public Health Sciences Unit, Glasgow, UK.
Huxley
R R
RR
The George Institute for International Health, University of Sydney, Sydney, Australia; Division of Epidemiology & Community Health, University of Minnesota, Minneapolis, USA.
Martiniuk
A L C
ALC
The George Institute for International Health, University of Sydney, Sydney, Australia. Electronic address: amartiniuk@george.org.au.
Barzi
F
F
The George Institute for International Health, University of Sydney, Sydney, Australia.
Lam
T H
TH
School of Public Health, The University of Hong Kong, Hong Kong, China.
Lawes
C M M
CMM
Clinical Trials Research Unit, University of Auckland, Auckland, New Zealand.
Giles
G G
GG
Cancer Epidemiology Centre, The Cancer Council, Victoria; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne; Centre for Molecular, Environmental, Genetic and Analytic Epidemiology, School of Population Health, University of Melbourne, Melbourne.
Welborn
T
T
Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia.
Ueshima
H
H
Department of Health Science, Shiga University of Medical Science, Shiga.
Tamakoshi
A
A
Department of Public Health, Aichi Medical University School of Medicine, Aichi-gun, Japan.
Woo
J
J
Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China.
Kim
H C
HC
Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, South Korea.
Fang
X
X
The George Institute for International Health, University of Sydney, Sydney, Australia; Department of Epidemiology and Social Medicine, Capital Medical University, Beijing, China.
Czernichow
S
S
The George Institute for International Health, University of Sydney, Sydney, Australia; Nutritional Epidemiology Research Unit, Public Health Department, Hôpital Avicenne & University Paris 13, Faculté SMBH, Bobigny, France.
Woodward
M
M
The George Institute for International Health, University of Sydney, Sydney, Australia; Department of Epidemiology, Johns Hopkins University, Baltimore, USA.
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001208:Asia; D044362:Australasia; D001786:Blood Glucose; D015331:Cohort Studies; D048909:Diabetes Complications / Q000150:complications* / Q000401:mortality*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications* / Q000401:mortality*; D016017:Odds Ratio
D001786:Blood Glucose