title: Association between diabetes and esophageal cancer, independent of obesity, in the United States Veterans Affairs population.
abstract: In the past 30 years, the incidence of esophageal adenocarcinoma (EAC) has increased more rapidly than any other cancer in the United States. The prevalence of obesity and diabetes mellitus has drastically increased as well. We explored the potential association between obesity, diabetes mellitus, and EAC. By means of retrospective interrogation of an administrative database from fiscal year 2005-2009, we identified two cohorts. The cancer cohort was defined as patients with adenocarcinoma of the distal esophagus or gastric cardia. The comparison cohort contained patients with gastroesophageal reflux disorder (GERD; diagnosis coupled with a procedure code for fundoplication). Patient data, including demographic measures, diagnoses of obesity, diabetes mellitus, dyslipidemia, alcohol abuse, and nicotine dependence were examined. A logistic regression model identified risk factors for development of EAC. The sample included 2,836 patients identified as having either EAC (1,704) or fundoplication with GERD (1,132). Although slightly higher percentages of the benign cohort were obese, the cancer cohort had more diabetics (30.8% vs. 14.8%; chi-square = 94.5; P < 0.0001). In a logistic regression analysis adjusting for comorbidity and lifestyle factors, diagnosis of diabetes mellitus was significantly associated with esophageal cancer as opposed to GERD without cancer (OR = 2.2; 95% confidence interval [CI] 1.7-2.8). Nicotine dependence was also identified as a risk factor (OR = 1.7; 95% CI 1.4-2.0). We identified a potential association between diabetes mellitus and adenocarcinoma of the esophagus or gastric cardia. This association appears to be independent of obesity. Additionally, nicotine dependence was identified as a risk factor for EAC.
authors.affiliation: Surgery Service, Central Texas Veterans Health Care System, Temple, TX, USA.|Department of Surgery, Scott & White Healthcare, Temple, TX, USA.
authors.forename: J L
authors.initials: JL
authors.lastname: Dixon
authors.affiliation: Center for Applied Health Research, jointly sponsored by Central Texas Veterans Health Care System and by Scott & White Healthcare, Temple, TX, USA.|Texas A&M Health Science Center, College Station, TX, USA.
authors.forename: L A
authors.initials: LA
authors.lastname: Copeland
authors.affiliation: Center for Applied Health Research, jointly sponsored by Central Texas Veterans Health Care System and by Scott & White Healthcare, Temple, TX, USA.|Texas A&M Health Science Center, College Station, TX, USA.
authors.forename: J E
authors.initials: JE
authors.lastname: Zeber
authors.affiliation: Health Services Research & Development, South Texas Veterans Health Care System, San Antonio, TX, USA.
authors.forename: A A
authors.initials: AA
authors.lastname: MacCarthy
authors.affiliation: Surgery Service, Central Texas Veterans Health Care System, Temple, TX, USA.|Department of Surgery, Scott & White Healthcare, Temple, TX, USA.
authors.forename: S I
authors.initials: SI
authors.lastname: Reznik
authors.affiliation: Surgery Service, Central Texas Veterans Health Care System, Temple, TX, USA.|Department of Surgery, Scott & White Healthcare, Temple, TX, USA.
authors.forename: W R
authors.initials: WR
authors.lastname: Smythe
authors.affiliation: Surgery Service, Central Texas Veterans Health Care System, Temple, TX, USA. philip.a.rascoe@uth.tmc.edu.|Department of Surgery, Scott & White Healthcare, Temple, TX, USA. philip.a.rascoe@uth.tmc.edu.
authors.forename: P A
authors.initials: PA
authors.lastname: Rascoe
mesh_terms: D000230:Adenocarcinoma / Q000453:epidemiology / Q000209:etiology*; D000368:Aged; D002299:Cardia; D016009:Chi-Square Distribution; D016208:Databases, Factual; D003924:Diabetes Mellitus, Type 2 / Q000150:complications*; D004938:Esophageal Neoplasms / Q000453:epidemiology / Q000209:etiology*; D004947:Esophagus; D005260:Female; D018662:Fundoplication; D005764:Gastroesophageal Reflux / Q000150:complications* / Q000628:therapy; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications*; D012189:Retrospective Studies; D012307:Risk Factors; D013274:Stomach Neoplasms / Q000453:epidemiology / Q000209:etiology*; D014029:Tobacco Use Disorder / Q000150:complications; D014481:United States / Q000453:epidemiology; D014493:United States Department of Veterans Affairs / Q000706:statistics & numerical data
keywords: adenocarcinoma; diabetes; epidemiology; esophageal cancer