title: Independent and joint effect of type 2 diabetes and gastric and hepatobiliary diseases on risk of pancreatic cancer risk: 10-year follow-up of population-based cohort.
abstract: BACKGROUND
  Type 2 diabetes mellitus, gastric and hepatobiliary comorbidities, and cancer share common risk factors: for example, tobacco, obesity, physical inactivity, high calorie intake, and metabolic disorders. Prior studies find type 2 diabetes and gastric and hepatobiliary comorbidities heightening risk of pancreatic cancer. Yet joint association of type 2 diabetes mellitus and gastric and hepatobiliary comorbidities on pancreatic cancer risk has not been assessed.
  
  
  METHODS
  This study rates independent/joint effects of type 2 diabetes as well as gastric and hepatobiliary comorbidity on pancreatic cancer risk for a retrospective population-based cohort of 166,850 type 2 diabetics identified in 1997-1998 and followed for 10-11 years, comparing their cancer incidence with that of 166,850 non-diabetics matched for age, gender, and locale. Time-dependent Cox's proportional hazards model evaluted joint association of type 2 diabetes and chronic conditions on pancreatic cancer risk.
  
  
  RESULTS
  A total of 1178 subjects were newly diagnosed with pancreatic cancer during follow-up, with incidence rates of 0.49 per 1000 person-years in type 2 diabetes and 0.26 per 1000 person-years in the non-diabetics. We observed greater magnitude of hazard ratios (HRs) of pancreatic cancer for patients with type 2 diabetes along with acute alcoholic hepatitis, acute pancreatitis, cholecystitis, and gastric ulcer compared with patients without type 2 diabetes or counterpart comorbidity (HR: 1.36, 95% confidence interval (CI): 1.19-1.56; 1.74, 1.23-2.45; 9.18, 7.44-11.33; and 2.31, 1.98-2.70, respectively). Main effects of type 2 diabetes were all statistically with narrow 95% CI and remained similar across risk stratification with various comorbidities: range 1.59-1.80.
  
  
  CONCLUSIONS
  Our study demonstrates that pre-existing type 2 diabetes, acute alcoholic hepatitis, acute pancreatitis, cholecystitis, and gastric ulcer independently or jointly predict subsequent pancreatic cancer risk. Clinicians must recognise burden of these gastric and hepatobiliary comorbidities and keep clinically vigilant for their diagnosis.
authors.affiliation: 1] Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan [2] School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan [3] Department of Medical Research, China Medical University Hospital, Taichung, Taiwan.
authors.forename: C-C
authors.initials: CC
authors.lastname: Lin
authors.affiliation: 1] Graduate Institute of Biostatistics, College of Management, China Medical University, Taichung, Taiwan [2] Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan [3] Research Center for Chinese Medicine and Acupuncture, China Medical University, Taichung, Taiwan.
authors.forename: J-H
authors.initials: JH
authors.lastname: Chiang
authors.affiliation: 1] School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan [2] Department of Medical Research, China Medical University Hospital, Taichung, Taiwan.
authors.forename: C-I
authors.initials: CI
authors.lastname: Li
authors.affiliation: 1] Division of Urology, Department of Surgery, Buddhist Tzu Chi General Hospital, Taichung Branch, Taichung, Taiwan [2] School of Medicine, Buddhist Tzu Chi University, Hualien, Taiwan [3] Graduate Institute of Clinical Medical Science, College of Medicine, China Medical University, Taichung, Taiwan.
authors.forename: T-F
authors.initials: TF
authors.lastname: Hsieh
authors.affiliation: 1] Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan [2] School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan [3] Department of Medical Research, China Medical University Hospital, Taichung, Taiwan.
authors.forename: C-S
authors.initials: CS
authors.lastname: Liu
authors.affiliation: 1] Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan [2] School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan.
authors.forename: W-Y
authors.initials: WY
authors.lastname: Lin
authors.affiliation: 1] Department of Psychiatry, Medical College, National Cheng-Kung University, Tainan, Taiwan [2] Global Development and Medical Affairs, Bristol-Myers Squibb (Taiwan) Ltd, Taipei, Taiwan.
authors.forename: Y-D
authors.initials: YD
authors.lastname: Lee
authors.affiliation: 1] Graduate Institute of Biostatistics, College of Management, China Medical University, Taichung, Taiwan [2] Research Center for Chinese Medicine and Acupuncture, China Medical University, Taichung, Taiwan [3] Department of Healthcare Administration, College of Medical and Health Science, Asia University, Taichung, Taiwan.
authors.forename: T-C
authors.initials: TC
authors.lastname: Li
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D003924:Diabetes Mellitus, Type 2 / Q000150:complications*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008107:Liver Diseases / Q000150:complications*; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000209:etiology*; D010195:Pancreatitis / Q000150:complications; D016016:Proportional Hazards Models; D012306:Risk; D013272:Stomach Diseases / Q000150:complications*