title: Association of diabetes and cancer mortality in American Indians: the Strong Heart Study.
abstract: OBJECTIVE
  The metabolic abnormalities that accompany diabetes mellitus are associated with an increased risk of many cancers. These associations, however, have not been well studied in American Indian populations, which experience a high prevalence of diabetes. The Strong Heart Study is a population-based, prospective cohort study with extensive characterization of diabetes status.
  
  
  METHODS
  Among a total cohort of 4,419 participants who were followed for up to 20 years, 430 cancer deaths were identified.
  
  
  RESULTS
  After adjusting for sex, age, education, smoking status, drinking status, and body mass index, participants with diabetes at baseline showed an increased risk of gastric (HR 4.09; 95% CI 1.42-11.79), hepatocellular (HR 2.94; 95% CI 1.17-7.40), and prostate cancer mortality (HR 3.10; 95% CI 1.22-7.94). Further adjustment for arsenic exposure showed a significantly increased risk of all-cause cancer mortality with diabetes (HR 1.27; 95% CI 1.03-1.58). Insulin resistance among participants without diabetes at baseline was associated with hepatocellular cancer mortality (HR 4.70; 95% CI 1.55-14.26).
  
  
  CONCLUSIONS
  Diabetes mellitus, and/or insulin resistance among those without diabetes, is a risk factor for gastric, hepatocellular, and prostate cancer in these American Indian communities, although relatively small sample size suggests cautious interpretation. Additional research is needed to evaluate the role of diabetes and obesity on cancer incidence in American Indian communities as well as the importance of diabetes prevention and control in reducing the burden of cancer incidence and mortality in the study population.
authors.affiliation: Epidemiology Department, Missouri Breaks Industries Research Inc., 118 S. Willow Str, Timber Lake, 57625, SD, USA. lbest@restel.com.|, 1935 118th Ave NW, Watford City, ND, 58854, USA. lbest@restel.com.
authors.forename: Lyle G
authors.initials: LG
authors.lastname: Best
authors.affiliation: Department of Environmental Health Sciences, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA.|Department of Preventive Medicine and Public Health, Universidad Autónoma de Madrid, Madrid, Spain.|CIBERESP, Madrid, Spain.
authors.forename: Esther
authors.initials: E
authors.lastname: García-Esquinas
authors.affiliation: Center for American Indian Health Research, College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.
authors.forename: Jeun-Liang
authors.initials: JL
authors.lastname: Yeh
authors.affiliation: Center for American Indian Health Research, College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.
authors.forename: Fawn
authors.initials: F
authors.lastname: Yeh
authors.affiliation: Center for American Indian Health Research, College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.
authors.forename: Ying
authors.initials: Y
authors.lastname: Zhang
authors.affiliation: Center for American Indian Health Research, College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.
authors.forename: Elisa T
authors.initials: ET
authors.lastname: Lee
authors.affiliation: MedStar Health Research Institute, Hyattsville, MD, USA.|Georgetown-Howard Universities Center for Clinical and Translational Science, Washington, DC, USA.
authors.forename: Barbara V
authors.initials: BV
authors.lastname: Howard
authors.affiliation: Division of Gynecology Oncology, Department of Obstetrics and Gynecology, Creighton University School of Medicine at St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA.
authors.forename: John H
authors.initials: JH
authors.lastname: Farley
authors.affiliation: Epidemiology Department, Missouri Breaks Industries Research Inc., 118 S. Willow Str, Timber Lake, 57625, SD, USA.
authors.forename: Thomas K
authors.initials: TK
authors.lastname: Welty
authors.affiliation: Stephenson Cancer Center and Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.
authors.forename: Dorothy A
authors.initials: DA
authors.lastname: Rhoades
authors.affiliation: Center for American Indian Health Research, College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.
authors.forename: Everett R
authors.initials: ER
authors.lastname: Rhoades
authors.affiliation: MedStar Health Research Institute, Hyattsville, MD, USA.
authors.forename: Jason G
authors.initials: JG
authors.lastname: Umans
authors.affiliation: Department of Environmental Health Sciences, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA.|Department of Oncology, Johns Hopkins School of Medicine, Baltimore, MD, USA.
authors.forename: Ana
authors.initials: A
authors.lastname: Navas-Acien
mesh_terms: D000368:Aged; D015992:Body Mass Index; D015331:Cohort Studies; D003920:Diabetes Mellitus / Q000453:epidemiology* / Q000401:mortality; D005260:Female; D006801:Humans; D015994:Incidence; D007198:Indians, North American / Q000706:statistics & numerical data*; D007333:Insulin Resistance; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000453:epidemiology* / Q000401:mortality; D009765:Obesity / Q000453:epidemiology* / Q000401:mortality; D015995:Prevalence; D011446:Prospective Studies; D012907:Smoking / Q000453:epidemiology
keywords: American Indian; Cancer; Diabetes mellitus