Increased risk of hepatocellular carcinoma in chronic hepatitis C patients with new onset diabetes

A nation-wide cohort study

Y. W. Huang, T. C. Wang, S. S. Yang, S. Y. Lin, S. C. Fu, J. T. Hu, C. J. Liu, J. H. Kao, D. S. Chen

Research output: Contribution to journalArticle

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Abstract

Background The impact of diabetes for hepatocellular carcinoma (HCC) development in chronic hepatitis C (CHC) patients remains controversial. Aim To investigate the risk of HCC in CHC patients who develop new onset diabetes. Methods We conducted a nation-wide cohort study by using Taiwanese National Health Insurance Research Database, which comprised of data from >99% of entire population. Among randomly sampled one million enrollees, 6251 adult CHC patients were identified from 1997 to 2009. Diabetes was defined as new onset in the patient who was given the diagnosis in the years 1999-2009 but not in 1997-1998. The cohorts of CHC with new onset diabetes (n = 1100) and 1:1 ratio age-, gender-, and inception point (onset date of diabetes) matched nondiabetes (n = 1087) were followed up from the inception point until the development of HCC, withdrawal from insurance, or December 2009. Results After adjustment for competing mortality, patients with new onset diabetes had a significantly higher cumulative incidence of HCC (Relative Risk = 1.544, 95% CI = 1.000-2.387, modified log-rank test, P = 0.047) as compared to those without. After adjustment for age, gender, cirrhosis, hyperlipidaemia, CHC treatment, diabetes treatment, comorbidity index, obesity and statins therapy by Cox proportional hazard model, diabetes was still an independent predictor for HCC (hazard ratio (HR) = 1.906, 95% CI = 1.102-3.295, P = 0.021). The risk for HCC was increased in those who were 40-59 years old, independent of other variables (HR = 3.086, 95% CI = 1.045-9.112, P = 0.041), and after adjustment for competing mortality (modified log-rank test, P = 0.009). Conclusion Chronic hepatitis C patients who develop diabetes are at an increased risk of hepatocellular carcinoma over time.

Original languageEnglish
Pages (from-to)902-911
Number of pages10
JournalAlimentary Pharmacology and Therapeutics
Volume42
Issue number7
DOIs
Publication statusPublished - Oct 1 2015

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Chronic Hepatitis C
Hepatocellular Carcinoma
Cohort Studies
Hydroxymethylglutaryl-CoA Reductase Inhibitors
Mortality
National Health Programs
Hyperlipidemias
Insurance
Proportional Hazards Models
Comorbidity
Fibrosis
Therapeutics
Obesity
Databases
Incidence
Research
Population

ASJC Scopus subject areas

  • Pharmacology (medical)

Cite this

Increased risk of hepatocellular carcinoma in chronic hepatitis C patients with new onset diabetes : A nation-wide cohort study. / Huang, Y. W.; Wang, T. C.; Yang, S. S.; Lin, S. Y.; Fu, S. C.; Hu, J. T.; Liu, C. J.; Kao, J. H.; Chen, D. S.

In: Alimentary Pharmacology and Therapeutics, Vol. 42, No. 7, 01.10.2015, p. 902-911.

Research output: Contribution to journalArticle

Huang, Y. W. ; Wang, T. C. ; Yang, S. S. ; Lin, S. Y. ; Fu, S. C. ; Hu, J. T. ; Liu, C. J. ; Kao, J. H. ; Chen, D. S. / Increased risk of hepatocellular carcinoma in chronic hepatitis C patients with new onset diabetes : A nation-wide cohort study. In: Alimentary Pharmacology and Therapeutics. 2015 ; Vol. 42, No. 7. pp. 902-911.
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abstract = "Background The impact of diabetes for hepatocellular carcinoma (HCC) development in chronic hepatitis C (CHC) patients remains controversial. Aim To investigate the risk of HCC in CHC patients who develop new onset diabetes. Methods We conducted a nation-wide cohort study by using Taiwanese National Health Insurance Research Database, which comprised of data from >99{\%} of entire population. Among randomly sampled one million enrollees, 6251 adult CHC patients were identified from 1997 to 2009. Diabetes was defined as new onset in the patient who was given the diagnosis in the years 1999-2009 but not in 1997-1998. The cohorts of CHC with new onset diabetes (n = 1100) and 1:1 ratio age-, gender-, and inception point (onset date of diabetes) matched nondiabetes (n = 1087) were followed up from the inception point until the development of HCC, withdrawal from insurance, or December 2009. Results After adjustment for competing mortality, patients with new onset diabetes had a significantly higher cumulative incidence of HCC (Relative Risk = 1.544, 95{\%} CI = 1.000-2.387, modified log-rank test, P = 0.047) as compared to those without. After adjustment for age, gender, cirrhosis, hyperlipidaemia, CHC treatment, diabetes treatment, comorbidity index, obesity and statins therapy by Cox proportional hazard model, diabetes was still an independent predictor for HCC (hazard ratio (HR) = 1.906, 95{\%} CI = 1.102-3.295, P = 0.021). The risk for HCC was increased in those who were 40-59 years old, independent of other variables (HR = 3.086, 95{\%} CI = 1.045-9.112, P = 0.041), and after adjustment for competing mortality (modified log-rank test, P = 0.009). Conclusion Chronic hepatitis C patients who develop diabetes are at an increased risk of hepatocellular carcinoma over time.",
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T1 - Increased risk of hepatocellular carcinoma in chronic hepatitis C patients with new onset diabetes

T2 - A nation-wide cohort study

AU - Huang, Y. W.

AU - Wang, T. C.

AU - Yang, S. S.

AU - Lin, S. Y.

AU - Fu, S. C.

AU - Hu, J. T.

AU - Liu, C. J.

AU - Kao, J. H.

AU - Chen, D. S.

PY - 2015/10/1

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N2 - Background The impact of diabetes for hepatocellular carcinoma (HCC) development in chronic hepatitis C (CHC) patients remains controversial. Aim To investigate the risk of HCC in CHC patients who develop new onset diabetes. Methods We conducted a nation-wide cohort study by using Taiwanese National Health Insurance Research Database, which comprised of data from >99% of entire population. Among randomly sampled one million enrollees, 6251 adult CHC patients were identified from 1997 to 2009. Diabetes was defined as new onset in the patient who was given the diagnosis in the years 1999-2009 but not in 1997-1998. The cohorts of CHC with new onset diabetes (n = 1100) and 1:1 ratio age-, gender-, and inception point (onset date of diabetes) matched nondiabetes (n = 1087) were followed up from the inception point until the development of HCC, withdrawal from insurance, or December 2009. Results After adjustment for competing mortality, patients with new onset diabetes had a significantly higher cumulative incidence of HCC (Relative Risk = 1.544, 95% CI = 1.000-2.387, modified log-rank test, P = 0.047) as compared to those without. After adjustment for age, gender, cirrhosis, hyperlipidaemia, CHC treatment, diabetes treatment, comorbidity index, obesity and statins therapy by Cox proportional hazard model, diabetes was still an independent predictor for HCC (hazard ratio (HR) = 1.906, 95% CI = 1.102-3.295, P = 0.021). The risk for HCC was increased in those who were 40-59 years old, independent of other variables (HR = 3.086, 95% CI = 1.045-9.112, P = 0.041), and after adjustment for competing mortality (modified log-rank test, P = 0.009). Conclusion Chronic hepatitis C patients who develop diabetes are at an increased risk of hepatocellular carcinoma over time.

AB - Background The impact of diabetes for hepatocellular carcinoma (HCC) development in chronic hepatitis C (CHC) patients remains controversial. Aim To investigate the risk of HCC in CHC patients who develop new onset diabetes. Methods We conducted a nation-wide cohort study by using Taiwanese National Health Insurance Research Database, which comprised of data from >99% of entire population. Among randomly sampled one million enrollees, 6251 adult CHC patients were identified from 1997 to 2009. Diabetes was defined as new onset in the patient who was given the diagnosis in the years 1999-2009 but not in 1997-1998. The cohorts of CHC with new onset diabetes (n = 1100) and 1:1 ratio age-, gender-, and inception point (onset date of diabetes) matched nondiabetes (n = 1087) were followed up from the inception point until the development of HCC, withdrawal from insurance, or December 2009. Results After adjustment for competing mortality, patients with new onset diabetes had a significantly higher cumulative incidence of HCC (Relative Risk = 1.544, 95% CI = 1.000-2.387, modified log-rank test, P = 0.047) as compared to those without. After adjustment for age, gender, cirrhosis, hyperlipidaemia, CHC treatment, diabetes treatment, comorbidity index, obesity and statins therapy by Cox proportional hazard model, diabetes was still an independent predictor for HCC (hazard ratio (HR) = 1.906, 95% CI = 1.102-3.295, P = 0.021). The risk for HCC was increased in those who were 40-59 years old, independent of other variables (HR = 3.086, 95% CI = 1.045-9.112, P = 0.041), and after adjustment for competing mortality (modified log-rank test, P = 0.009). Conclusion Chronic hepatitis C patients who develop diabetes are at an increased risk of hepatocellular carcinoma over time.

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