Diabetes and Cause-Specific Mortality in a Prospective Cohort of One Million U.S. Adults

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Peter T. Campbell, Ph.D., Christina C. Newton, M.S.P.H., Alpa V. Patel, Ph.D., Eric J. Jacobs, Ph.D., Susan M. Gapstur, Ph.D.

Diabetes Care Volume 35: 1835-1844

September, 2012

Study Objective

• To examine the association of diabetes on cause-specific mortality, including deaths from specific cancers

Campbell P et al. Diabetes Care 2012;35:1835-1844

Study Design & Methods

• Prospective cohort included 1,053,831 U.S. adults without cancer at baseline, enrolled in the Cancer Prevention Study-II in 1982 and followed for mortality until December 2008

• At baseline, participants completed a self-administered questionnaire including information on diabetes, smoking, physical activity, height, and weight

• Multivariable-adjusted relative risks (RRs) (95% CI) were estimated using the Cox proportional hazards regression

Campbell P et al. Diabetes Care 2012;35:1835-1844

Results

• During 26 years of follow-up, 243,051 men and 222,109 women died

• In multivariable models that controlled for age, BMI, and other variables, diabetes was associated with higher risk of all-cause mortality (women RR 1.90 [95% CI 1.87–1.93]; men 1.73 [1.70–1.75])

Campbell P et al. Diabetes Care 2012;35:1835-1844

Results

• Diabetes associated with higher risk of death from the following cancers:

• Among women: o Liver (1.40 [1.05–1.86])o Pancreas (1.31 [1.14–1.51])o Endometrium (1.33 [1.08–1.65])o Colon (1.18 [1.04–1.33])o Breast (1.16 [1.03–1.29])

• Among men: o Breast (4.20 [2.20–8.04])o Liver (2.26 [1.89–2.70])o Oral cavity and pharynx (1.44 [1.07–1.94])o Pancreas (1.40 [1.23–1.59])o Bladder (1.22 [1.01–1.47])o Colon (1.15 [1.03–1.29])o (Inversely) prostate (0.88 [0.79–0.97])

Campbell P et al. Diabetes Care 2012;35:1835-1844

Results

• Diabetes associated with higher risks of death involving the circulatory system, respiratory system, digestive system, genitourinary system, and external causes/accidental deaths

Campbell P et al. Diabetes Care 2012;35:1835-1844

Campbell P et al. Diabetes Care 2012;35:1835-1844

Campbell P et al. Diabetes Care 2012;35:1835-1844

Campbell P et al. Diabetes Care 2012;35:1835-1844

Campbell P et al. Diabetes Care 2012;35:1835-1844

Campbell P et al. Diabetes Care 2012;35:1835-1844

Campbell P et al. Diabetes Care 2012;35:1835-1844

Conclusions

• Diabetes associated with higher risk of death for many diseases, including several specific forms of cancer

Campbell P et al. Diabetes Care 2012;35:1835-1844