Aims: To determine whether diabetes is associated with all-cause, cancer-related and cardiovascular disease (CVD) mortality and examine the effect of duration of diabetes on mortality in breast, prostate and colorectal cancer survivors.
Methods: National Health Interview Survey (NHIS) was used to select 37,993 adults cancer survivors from 1997 to 2013 linked data retrieved from the National Death Index through December 31, 2015. Cox proportional-hazards models were used to assess associations between diabetes and all-cause and cause-specific mortality.
Results: Over a median follow-up period of 13 years, 2,346 all-cause, 698 cancer and 506 CVD deaths occurred. Among all cancer survivors, patients with diabetes had hazard ratios (HR) of 1.36 (95% CI=1.28-1.44) for all-cause mortality, 1.14 for cancer-specific mortality (95% CI=1.03-1.27), 1.36 for CVD mortality (95% CI=1.18-1.55), 17.18 for diabetes related mortality (95% CI=11.51-25.64) and 2.51 for kidney disease mortality (95% CI=1.65-3.82). For specific cancer sites, the HRs for all-cause mortality among survivors with diabetes diagnosed with breast cancer, prostate cancer and colorectal cancer. Diabetes increased the risk of cancer-specific mortality among colorectal cancer survivors compared to nondiabetic survivors. However, there is no the increasing risk in breast or prostate cancer survivors with diabetes. Diabetes was associated with higher risk of diabetes related mortality when compared to nondiabetic breast, prostate and colorectal cancer survivors. Cancer survivors with diabetes had similar risk of all-cause and CVD mortality during the second 5 years of diabetes and above 10 years of diabetes as compared to nondiabetic patients.
Conclusions: Diabetes increased the risk of all-cause mortality among breast, prostate, and colorectal cancer survivors. Greater attention on diabetes management is warranted in cancer survivors with diabetes.
X. Chen: None. J. Xiao: None. Y. Wang: None. F. Shen: None.
Natural Science Foundation of Zhejiang Province (LWY20H020001); China Scholarship Council (201908330235); Science and Technology Project of Wenzhou Science and Technology Bureau (Y20190125); First Affiliated Hospital of Wenzhou Medical University (FHY2019015)