title: All-cause cancer mortality over 15 years in multi-ethnic Mauritius: the impact of diabetes and intermediate forms of glucose tolerance.
abstract: There are accumulating data describing the association between diabetes and cancer mortality from Westernised populations. There are no data describing the relationship between diabetes and cancer mortality in African or South Asian populations from developing countries. We explored the relationship of abnormal glucose tolerance and diabetes on cancer mortality risk in a large, multi-ethnic cohort from the developing nation of Mauritius. Population-based surveys were undertaken in 1987, 1992 and 1998. The 9559 participants comprised 66% of South Asian (Indian), 27% of African (Creole), and 7% of Chinese descent. Cox's proportional hazards model with time varying covariates was used to obtain hazard ratios (HRs) and 95% confidence intervals (95% CI) for risk of cancer mortality, after adjustment for confounding factors. In men, but not women, cancer mortality risk increased with rising 2h-PG levels with HR for the top versus bottom quintile of 2.77 (95%CI: 1.28 to 5.98). South Asian men with known diabetes had a significantly greater risk of cancer mortality than those with normal glucose tolerance (NGT) HR: 2.74 (95%CI: 1.00-7.56). Overall, impaired glucose tolerance was associated with an elevated risk of cancer mortality compared to NGT (HR: 1.47, 95% CI: 0.98-2.19), though this was not significant. We have shown that the association between abnormal glucose tolerance and cancer extends to those of African and South Asian descent. These results highlight the importance of understanding this relationship in a global context to direct future health policy given the rapid increase in type 2 diabetes, especially in developing nations.
authors.affiliation: Department of Clinical Diabetes and Epidemiology, Baker IDI Heart and Diabetes Institute, Melbourne, Australia. Jessica.harding@bakeridi.edu.au
authors.forename: Jessica L
authors.initials: JL
authors.lastname: Harding
authors.forename: Stefan
authors.initials: S
authors.lastname: Soderberg
authors.forename: Jonathan E
authors.initials: JE
authors.lastname: Shaw
authors.forename: Paul Z
authors.initials: PZ
authors.lastname: Zimmet
authors.forename: Vassen
authors.initials: V
authors.lastname: Pauvaday
authors.forename: Sudhir
authors.initials: S
authors.lastname: Kowlessur
authors.forename: Jaakko
authors.initials: J
authors.lastname: Tuomilehto
authors.forename: K George M M
authors.initials: KG
authors.lastname: Alberti
authors.forename: Dianna
authors.initials: D
authors.lastname: J Magliano
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D015897:Comorbidity; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology; D005260:Female; D018149:Glucose Intolerance / Q000453:epidemiology; D006801:Humans; D008297:Male; D008436:Mauritius / Q000453:epidemiology / Q000208:ethnology; D008875:Middle Aged; D009369:Neoplasms / Q000453:epidemiology* / Q000401:mortality; D012307:Risk Factors; D055815:Young Adult