The association of diabetes mellitus with subsequent internal cancers in the arsenic-exposed area of Taiwan

Ling I. Hsu, Yuan Hung Wang, Hung Yi Chiou, Meei Maan Wu, Tse Yen Yang, Yu Hsin Chen, Chin Hsiao Tseng, Chien Jen Chen

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3 Citations (Scopus)

Abstract

Background: Epidemiological studies have shown that diabetes mellitus (DM) is associated with an increased risk of cancer. The aim of this study was to examine the association of diabetes with subsequent internal cancers in an arsenic-exposed area where the prevalence of diabetes is remarkably higher than in the general Taiwan population. Methods: The southwestern cohort was recruited from blackfoot disease (BFD) endemic townships with high arsenic levels in their well water, while the northeastern cohort was recruited from four townships in the Lanyang Basin with low-to-moderate arsenic level in their well water. These two cohorts were combined and a total of 9525 subjects were recruited for the analysis. The disease status of the subjects, including diabetes, hypertension or dyslipidemia, was ascertained through linkage with the computerized Taiwan National Health Insurance (NHI) database, while the cancer status of the subjects was ascertained through linkage with National Cancer Registry and via the NHI database for major illness/injury certificates/catastrophic illness cards. The subjects were followed from study entry through December 31, 2009. Cox regression analysis with time-dependent DM status was used to determine the hazard ratios (HRs) and 95% confidence intervals (CIs) for developing internal malignancies. Results: Diabetic patients had a 58% higher risk of any site internal cancer compared to non-DM individuals (HR, 1.58; 95% CI: 1.39-1.79) after adjusting for age, sex, education level, cigarette smoking, alcohol drinking, geographical location, cumulative arsenic exposure and history of hypertension or dyslipidemia. A significant association of DM with cancers of the stomach (HR, 1.75; 95% CI: 1.12-2.76), colon (HR, 1.76; 95% CI: 1.20-2.59), liver (HR, 2.46; 95% CI: 1.81-3.34), pancreas (HR, 2.80; 95% CI: 1.30-6.20) and lungs (HR, 1.35; 95% CI: 1.04-1.76) was observed. The association with lung, bladder and kidney cancer was largely confined to diabetic patients with arsenic level in consumed water ≧500. μg/L, while the association with other cancer sites did not show such an effect. With the adjustment of arsenic exposure, marked attenuation for the association was observed, suggesting high level arsenic exposure plays an important role in the development of diabetes mellitus and concomitantly lung, bladder and kidney cancer.

Original languageEnglish
Pages (from-to)452-459
Number of pages8
JournalJournal of Asian Earth Sciences
Volume73
DOIs
Publication statusPublished - Sep 5 2013

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diabetes
arsenic
cancer
confidence interval
hazard
health insurance
hypertension
well water
drinking
smoking
alcohol
regression analysis
education

Keywords

  • Arsenic
  • Diabetes mellitus
  • Internal cancers

ASJC Scopus subject areas

  • Earth-Surface Processes
  • Geology

Cite this

The association of diabetes mellitus with subsequent internal cancers in the arsenic-exposed area of Taiwan. / Hsu, Ling I.; Wang, Yuan Hung; Chiou, Hung Yi; Wu, Meei Maan; Yang, Tse Yen; Chen, Yu Hsin; Tseng, Chin Hsiao; Chen, Chien Jen.

In: Journal of Asian Earth Sciences, Vol. 73, 05.09.2013, p. 452-459.

Research output: Contribution to journalArticle

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abstract = "Background: Epidemiological studies have shown that diabetes mellitus (DM) is associated with an increased risk of cancer. The aim of this study was to examine the association of diabetes with subsequent internal cancers in an arsenic-exposed area where the prevalence of diabetes is remarkably higher than in the general Taiwan population. Methods: The southwestern cohort was recruited from blackfoot disease (BFD) endemic townships with high arsenic levels in their well water, while the northeastern cohort was recruited from four townships in the Lanyang Basin with low-to-moderate arsenic level in their well water. These two cohorts were combined and a total of 9525 subjects were recruited for the analysis. The disease status of the subjects, including diabetes, hypertension or dyslipidemia, was ascertained through linkage with the computerized Taiwan National Health Insurance (NHI) database, while the cancer status of the subjects was ascertained through linkage with National Cancer Registry and via the NHI database for major illness/injury certificates/catastrophic illness cards. The subjects were followed from study entry through December 31, 2009. Cox regression analysis with time-dependent DM status was used to determine the hazard ratios (HRs) and 95{\%} confidence intervals (CIs) for developing internal malignancies. Results: Diabetic patients had a 58{\%} higher risk of any site internal cancer compared to non-DM individuals (HR, 1.58; 95{\%} CI: 1.39-1.79) after adjusting for age, sex, education level, cigarette smoking, alcohol drinking, geographical location, cumulative arsenic exposure and history of hypertension or dyslipidemia. A significant association of DM with cancers of the stomach (HR, 1.75; 95{\%} CI: 1.12-2.76), colon (HR, 1.76; 95{\%} CI: 1.20-2.59), liver (HR, 2.46; 95{\%} CI: 1.81-3.34), pancreas (HR, 2.80; 95{\%} CI: 1.30-6.20) and lungs (HR, 1.35; 95{\%} CI: 1.04-1.76) was observed. The association with lung, bladder and kidney cancer was largely confined to diabetic patients with arsenic level in consumed water ≧500. μg/L, while the association with other cancer sites did not show such an effect. With the adjustment of arsenic exposure, marked attenuation for the association was observed, suggesting high level arsenic exposure plays an important role in the development of diabetes mellitus and concomitantly lung, bladder and kidney cancer.",
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AU - Wu, Meei Maan

AU - Yang, Tse Yen

AU - Chen, Yu Hsin

AU - Tseng, Chin Hsiao

AU - Chen, Chien Jen

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N2 - Background: Epidemiological studies have shown that diabetes mellitus (DM) is associated with an increased risk of cancer. The aim of this study was to examine the association of diabetes with subsequent internal cancers in an arsenic-exposed area where the prevalence of diabetes is remarkably higher than in the general Taiwan population. Methods: The southwestern cohort was recruited from blackfoot disease (BFD) endemic townships with high arsenic levels in their well water, while the northeastern cohort was recruited from four townships in the Lanyang Basin with low-to-moderate arsenic level in their well water. These two cohorts were combined and a total of 9525 subjects were recruited for the analysis. The disease status of the subjects, including diabetes, hypertension or dyslipidemia, was ascertained through linkage with the computerized Taiwan National Health Insurance (NHI) database, while the cancer status of the subjects was ascertained through linkage with National Cancer Registry and via the NHI database for major illness/injury certificates/catastrophic illness cards. The subjects were followed from study entry through December 31, 2009. Cox regression analysis with time-dependent DM status was used to determine the hazard ratios (HRs) and 95% confidence intervals (CIs) for developing internal malignancies. Results: Diabetic patients had a 58% higher risk of any site internal cancer compared to non-DM individuals (HR, 1.58; 95% CI: 1.39-1.79) after adjusting for age, sex, education level, cigarette smoking, alcohol drinking, geographical location, cumulative arsenic exposure and history of hypertension or dyslipidemia. A significant association of DM with cancers of the stomach (HR, 1.75; 95% CI: 1.12-2.76), colon (HR, 1.76; 95% CI: 1.20-2.59), liver (HR, 2.46; 95% CI: 1.81-3.34), pancreas (HR, 2.80; 95% CI: 1.30-6.20) and lungs (HR, 1.35; 95% CI: 1.04-1.76) was observed. The association with lung, bladder and kidney cancer was largely confined to diabetic patients with arsenic level in consumed water ≧500. μg/L, while the association with other cancer sites did not show such an effect. With the adjustment of arsenic exposure, marked attenuation for the association was observed, suggesting high level arsenic exposure plays an important role in the development of diabetes mellitus and concomitantly lung, bladder and kidney cancer.

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