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Racial disparities in colorectal cancer incidence by type 2 diabetes mellitus status

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Abstract

Purpose

Type 2 diabetes mellitus (T2DM) prevalence has increased dramatically in the United States since the early 1970s. Though T2DM is known to be associated with colorectal cancer (CRC), information on racial differences in the relationship between T2DM and CRC is limited.

Methods

Using a retrospective cohort design, we compared the association between T2DM and CRC, including subsites of the colon, in African Americans (AAs) and European Americans (EAs) in South Carolina, a region with large racial disparities in rates of both diseases. A total of 91,836 individuals who were ≥30 years old on 1 January 1990 and had ≥12 months of South Carolina Medicaid eligibility between 1 January 1990 and 31 December 1995 were included in the analyses. Cancer data from 1996 to 2007 included information on anatomic subsite.

Results

Subjects who had T2DM (n = 6,006) were >50 % more likely to be diagnosed with colon cancer compared to those without T2DM (n = 85,681). The association between T2DM and colon cancer was higher in AAs [odds ratio (OR) = 1.72 (95 % confidence interval: 1.21, 2.46); n = 47,984] than among EAs (OR = 1.24; 0.73, 2.11; n = 43,703). Overall, individuals with T2DM were over twice as likely to be diagnosed with in situ or local colon cancer (OR = 2.12; 1.40, 3.22; n = 191) compared to those without T2DM, with a higher likelihood among AAs (OR = 2.49; 1.52, 4.09; n = 113).

Conclusions

Results from a Medicaid population in a high-risk region of the United States showed an increased likelihood of CRC with T2DM and suggest a racial disparity that disfavors AAs and provides further impetus for efforts aimed at diabetes prevention in this group.

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Abbreviations

AAs:

African Americans

CRC:

Colorectal cancer

EAs:

European Americans

OR:

Odds ratio

SCCCR:

South Carolina Central Cancer Registry

SIR:

Standardized incidence ratio

T2DM:

Type 2 diabetes mellitus

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Acknowledgments

Funding was provided by the National Cancer Institute, Center for Research and Cancer Health Disparities (Community Networks Program) to the South Carolina Cancer Disparities Community Network (SCCDCN) [1U54 CA153461 Hebert, JR (PI)]; the South Carolina Central Cancer Registry (SCCCR) funded by the CDC National Program of Cancer Registries [U55CCU421931]. Dr. Hébert was supported by an Established Investigator Award in Cancer Prevention and Control from the Cancer Training Branch of the National Cancer Institute (K05 CA136975). The Cancer Prevention and Control Program of the University of South Carolina provided support to Drs. Cavicchia, Adams, Steck, and Hébert. We would like to acknowledge the support of the staffs of the South Carolina Central Cancer Registry, especially Deborah Hurley and Jonathan Savoy, for access to cancer-related data and the South Carolina Budget and Control Board’s Office of Research Statistics, especially Heather Kirby, for access to Medicaid data including information on diabetes.

Conflict of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. South Carolina Statewide Cancer Prevention and Control Program, University of South Carolina, 915 Greene Street, Suite 241-2, Columbia, SC, 29208, USA

    Philip P. Cavicchia, Swann Arp Adams, Susan E. Steck & James R. Hebert

  2. Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, 800 Sumter Street, Columbia, SC, 29208, USA

    Philip P. Cavicchia, Swann Arp Adams, Susan E. Steck, James R. Hussey, Jihong Liu & James R. Hebert

  3. Florida Department of Health, Tallahassee, FL, 32399, USA

    Philip P. Cavicchia

  4. South Carolina Department of Health and Environmental Control, Columbia, SC, 29201, USA

    Virginie G. Daguisé

  5. College of Nursing, University of South Carolina, Columbia, SC, 29208, USA

    Swann Arp Adams

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  1. Philip P. Cavicchia
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  2. Swann Arp Adams
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  3. Susan E. Steck
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  5. Jihong Liu
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  6. Virginie G. Daguisé
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  7. James R. Hebert
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Corresponding author

Correspondence to James R. Hebert.

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Institutional Review Board approvals were obtained from the University of South Carolina and the South Carolina Department of Health and Environmental Control.

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Cavicchia, P.P., Adams, S.A., Steck, S.E. et al. Racial disparities in colorectal cancer incidence by type 2 diabetes mellitus status. Cancer Causes Control 24, 277–285 (2013). https://doi.org/10.1007/s10552-012-0095-7

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  • DOI: https://doi.org/10.1007/s10552-012-0095-7

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