Elsevier

Primary Care Diabetes

Volume 15, Issue 3, June 2021, Pages 518-521
Primary Care Diabetes

Original research
The significant interaction between age and diabetes mellitus for colorectal cancer: Evidence from NHANES data 1999–2016

https://doi.org/10.1016/j.pcd.2021.02.006Get rights and content

Highlights

  • SAS version 9.4's Procedure Survey methodology was applied.

  • NHANES data analysis found subjects with DM at age ≥65 do not increase risk for CRC.

  • Analysis confirmed subjects with DM at ages 18–65 years have a higher risk for CRC.

Abstract

Background

Diabetes mellitus has been associated with elevated risk of colorectal cancer (CRC), although interaction between age and DM is unclear. We examined the relationship among DM, CRC and age.

Methods

22,580 subjects aged ≥18 years were identified from the National Health and Nutrition Examination Survey (NHANES) database collected between 1999–2016. To account for the complex, stratified, multistage probability sampling design in NHANES, SASv9.4 Procedure Survey Methodology was applied. Univariate analysis compared individual baseline characteristics between subjects with and without DM. Multivariate logistic regression model assessed association between DM and CRC, in which the model included factors with p < 0.05 in univariate analysis as covariates.

Results

Univariate analysis showed significant differences in age (p < 0.0001), race (p < 0.0001), smoking (p = 0.0023) and body mass index (p < 0.0001) between No-DM and DM. Multivariate analysis revealed significant interaction between age and DM (p = 0.0004). Subjects with DM aged 18–65 were more likely to experience CRC (OR = 4.47, 95%CI = (1.33–15.07); p = 0.0157) compared to those without DM. Subjects with DM aged >65 were not at increased risk for CRC (OR = 0.83, 95%CI = (0.43–1.59); p = 0.5665) compared to those without DM.

Conclusions

Age, DM, and interaction between age and DM are risk factors for CRC. Individuals with DM aged 18–65 years have a higher CRC risk.

Introduction

Diabetes Mellitus (DM) is increasing in prevalence in the United States, affecting nearly 10% of the adult population [1], and colorectal cancer (CRC) is the second cause of cancer death in women, and the third for men [2]. According to cancer statistics in the United States in 2017, there were estimated to be 135,430 individuals newly diagnosed with CRC and 50,260 deaths from the disease [3]. These two diseases are life threatening and huge burdens to patients and society. Diabetes was the seventh leading cause of death in the United States in 2015, and after adjusting for age group and sex, the average medical expenditures among people with diagnosed DM were approximately 2.3 times higher than expenditures for those without DM [4], [5].

There is much evidence that DM is an independent risk factor for the development of CRC. However, the reason why DM can be a risk factor for colorectal cancer is unclear [6]. DM has been repeatedly shown to be associated with CRC. In a large, population-based cohort study of postmenopausal women, type 2 DM was found to be associated with a 40% increase in the risk for incident CRC [7]. Some studies found CRC has been associated with markers of insulin or glucose control and insulin resistance might be the unifying mechanism by which several risk factors affect colorectal carcinogenesis. In accordance with previous studies, DM was observed to be a moderate risk factor for CRC [8].

The National Diabetes Statistics reports that 87.5% (95% CI, 84.8%–89.7%) of adults are overweight or obese, defined as a body mass index (BMI) of 25 kg/m2 or higher [1]. Overweight, obesity, or BMI have been consistently associated with increased risk for CRC incidence and mortality [9]. Sturmer et al. reported that genetic variation in the insulin-like growth factor (IGF) pathway may further increase the risk of CRC associated with BMI [10].

Although studies have shown that DM is associated with an elevated risk of CRC, any interaction between age and DM has not been well defined. In this study, we examined the relationship among DM, CRC and age through analyzing data collected by the National Health and Nutrition Examination Survey (NHANES) from 1999 to 2016 to reveal the association between DM and CRC in different age ranges.

Section snippets

Study population

NHANES is a survey research program conducted by the Centers of Disease Control and Prevention to assess the health and nutritional status of adults and children in the United States. It is composed of cross-sectional, nationally representative health and nutrition surveys of the U.S. civilian, non- institutionalized population. In order to represent the U.S. population, a complex, stratified, multistage probability cluster sampling design is used in the survey. Selected subpopulations are

Results

Data from 22,580 subjects aged ≥18 years and with fasting blood sugar test values were analyzed. There were 20,896 subjects in the No-DM group, with a mean age of 45.4 years, female rate of 52.2%, and CRC rate of 0.45% and 1686 subjects in the DM group, with a mean age of 59.4 years, female rate of 46.0%, and CRC rate of 1.11% (Table 1).

Univariate analysis showed that the differences in age (p < 0.0001), sex (p < 0.0001), race (p < 0.0001), smoking (p = 0.002), and BMI (p < 0.0001) between No-DM and DM

Discussion

This study indicated that individuals with DM at ages 18–65 years were at significantly higher risk for CRC. However, in individuals aged ≥65 years, DM was not a significant risk factor for CRC. The results of this study support considering DM in diagnosis, screening, and managing individuals aged less than 65 years for CRC, and suggest DM is no more a risk factor for CRC in the individuals aged equal or greater than 65. Although the previous studies Ali Khan et al. [12] and Sander de Kort et

Conclusion

This study showed that age, DM, and interaction between age and DM are important risk factors for CRC. Individuals with DM at ages 18–65 years have a higher risk for CRC. However, individuals with DM at age ≥65 years have no increased risk for CRC.

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Conflict of interest

No relevant financial disclosures for all authors.

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