Abstract
Diabetes prevalence and racial health disparities in the diabetic population are increasing in the US. Population‐based cancer‐specific survival estimates for cancer patients with diabetes have not been assessed. The Surveillance, Epidemiology, and End Results (SEER)‐Medicare linkage provided data on cancer‐specific deaths and diabetes prevalence among 14 separate cohorts representing 1 068 098 cancer patients ages 66 + years diagnosed between 2000 and 2011 in 17 SEER areas. Cancer‐specific survival estimates were calculated by diabetes status adjusted by age, stage, comorbidities, and cancer treatment, and stratified by cancer site and sex with whites without diabetes as the reference group. Black patients had the highest diabetes prevalence particularly among women. Risks of cancer deaths were increased across most cancer sites for patients with diabetes regardless of race. Among men the largest effect of having diabetes on cancer‐specific deaths were observed for black men diagnosed with Non‐Hodgkin lymphoma (NHL) (HR = 1.53, 95%CI = 1.33‐1.76) and prostate cancer (HR = 1.37, 95%CI = 1.32‐1.42). Diabetes prevalence was higher for black females compared to white females across all 14 cancer sites and higher for most sites when compared to white and black males. Among women the largest effect of having diabetes on cancer‐specific deaths were observed for black women diagnosed with corpus/uterus cancer (HR = 1.66, 95%CI = 1.54‐1.79), Hodgkin lymphoma (HR = 1.62, 95%CI = 1.02‐2.56) and breast ER+ (HR = 1.39, 95%CI = 1.32‐1.47). The co‐occurrence of diabetes and cancer significantly increases the risk of cancer death. Our study suggests that these risks may vary by cancer site, and indicates the need for future research to address racial and sex disparities and enhance understanding how prevalent diabetes may affect cancer deaths.
Highlights
The prevalence of diabetes in the United States (US) has been steadily increasing over the past 25 years[1] and appears to mirror increasing prevalence of obesity in the US
Our study provides estimations of the extent to which coexisting diabetes increases risk of cancer-specific death; it appears that this increased risk is present for most cancer sites
The differing death risks by cancer site for white males and females compared to black males and females, suggest the need for further research to examine how prevalent diabetes can affect cancer deaths differently by race
Summary
The prevalence of diabetes in the United States (US) has been steadily increasing over the past 25 years[1] and appears to mirror increasing prevalence of obesity in the US. Many potential hypotheses for these differences have been proposed; the possible influence of the much higher prevalence of diabetes among black compared to white cancer patients has not been explored in depth. Several studies have investigated possible differences in cancer-s pecific survival between white and black cancer patients with and without diabetes, but these studies have been limited to examining a single cancer patient population or have been drawn from more selected patient populations that may be less representative of the overall US cancer patient populations.[16-20]. In this study, we used 2 unique national data resources, the Surveillance, Epidemiology, and End Results (SEER)-linked Medicare claims data to identify black and white cancer patients 66 years and older, representing more than 50% of new cancer cases, with and without prevalent diabetes to determine differences in the risk of cancer death.[21]
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