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Canadian Journal of Public Health

, Volume 104, Issue 2, pp e101–e107 | Cite as

Diabetes and Sex-specific Colorectal Cancer Risks in Newfoundland and Labrador: A Population-based Retrospective Cohort Study

  • Khokan C. Sikdar
  • Stephanie J. Walsh
  • Madonna Roche
  • Ying Jiang
  • Ania Syrowatka
  • Kayla D. Collins
Quantitative Research

Abstract

OBJECTIVE: Studies on the relationship between diabetes and colorectal cancer (CRC) are inconsistent. It is also unclear whether CRC risk elevation for individuals with diabetes is similar for males and females. Using data from Newfoundland and Labrador (NL), the province with the highest CRC incidence and diabetes prevalence in Canada, we assessed and compared the risk elevation of CRC for males and females with diabetes, overall and by anatomic subsite.

METHODS: A population-based retrospective cohort study including a study sample of 122,228 individuals aged ≥30 years was conducted using administrative health databases over a 10.5-year period (October 1, 1996 to March 31, 2007). Hazard ratios were estimated using Cox proportional hazard models.

RESULTS: In comparison with non-diabetes counterparts, both males and females with diabetes were at a significantly elevated risk of overall CRC, with corresponding hazard ratios of 1.38 and 1.52, respectively. For males, diabetes significantly increased the risk of proximal and distal colon cancers, but not of rectal cancer. For females, diabetes significantly increased the risk of proximal colon and rectal cancers, but not of distal colon cancer. The results suggest that there is a stronger association between diabetes and CRC for females than for males, and the association did not change after adjusting for overweight/obesity.

CONCLUSIONS: Diabetes led to a greater risk of CRC in both the male and female population in NL. Risk was subsite-specific and varied by sex. Future research should examine reasons for the observed diabetes-associated CRC risk to support CRC prevention strategies among the diabetes population.

Key Words

Colorectal cancer diabetes mellitus cohort study hazard ratio risk elevation 

Résumé

Objectif: Les études de la relation entre le diabète et le cancer colorectal (CCR) sont contradictoires. Il n’est pas clair non plus si l’élévation du risque de CCR chez les sujets diabétiques est semblable chez les hommes et les femmes. À l’aide de données de Terre-Neuve-et- Labrador (T.-N.-L.), la province du Canada où l’incidence du CCR et la prévalence du diabète sont les plus élevées, nous avons estimé et comparé l’élévation du risque de CCR pour les hommes et les femmes diabétiques, globalement et par sous-site anatomique.

MÉTHODE: Nous avons mené une étude de cohorte rétrospective populationnelle sur un échantillon de 122 228 sujets de ≥30 ans puisé dans les bases de données administratives sur la santé sur une période de 10,5 ans (1er octobre 1996 au 31 mars 2007). Les coefficients de danger ont été estimés à l’aide des modèles de régression à effet proportionnel de Cox.

RÉSULTATS: Par comparaison avec les sujets non diabétiques, les hommes et les femmes diabétiques présentaient un risque global de CCR significativement élevé, avec des coefficients de danger de 1,38 et de 1,52, respectivement. Chez les hommes, le diabète augmentait significativement le risque de cancers du côlon proximal et distal, mais pas le risque de cancer rectal. Chez les femmes, le diabète augmentait significativement le risque de cancer du côlon proximal et de cancer rectal, mais pas le risque de cancer du côlon distal. Ces résultats montrent que l’association entre le diabète et le CCR est plus forte chez les femmes que chez les hommes; cette association reste inchangée après la prise en considération du surpoids et de l’obésité.

CONCLUSIONS: Le diabète entraîne un plus grand risque de CCR tant chez les hommes que chez les femmes à T.-N.-L. Le risque est propre au sous-site et varie selon le sexe. Les études futures devraient porter sur les raisons du risque observé de CCR associé au diabète pour appuyer des stratégies de prévention du CCR dans la population diabétique.

Mots Clés

cancer colorectal diabète études de cohortes coefficient de danger élévation du risque 

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Copyright information

© The Canadian Public Health Association 2013

Authors and Affiliations

  • Khokan C. Sikdar
    • 1
    • 2
  • Stephanie J. Walsh
    • 3
  • Madonna Roche
    • 2
    • 3
  • Ying Jiang
    • 4
  • Ania Syrowatka
    • 4
  • Kayla D. Collins
    • 2
    • 3
  1. 1.School of Public HealthUniversity of AlbertaEdmontonCanada
  2. 2.Faculty of MedicineMemorial University of NewfoundlandSt. John’sCanada
  3. 3.Research and Evaluation Department, Newfoundland and Labrador Centre for Health InformationSt. John’sCanada
  4. 4.Centre for Chronic Disease Prevention and ControlPublic Health Agency of CanadaOttawaCanada

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