Abstract
BackgroundPrevious studies have suggested that chronic obstructive pulmonary disease (COPD) is an independent risk factor for lung cancer. There are some evidence that people with diabetes are at a risk of developing many forms of cancer, but inconclusive with regard to lung cancer. The aim of this study was to evaluate whether COPD with or without type 2 diabetes mellitus (T2DM) influences the risk of developing lung cancer.MethodsThis is a retrospective cohort study consisting of 20,730 subjects newly diagnosed with COPD (“cases”). Their data was collected from the National Health Insurance system of Taiwan from 1998 to 2010. Among these patients, 5,820 patients had T2DM and 14,910 patients did not have T2DM. The retrospective matched control group consisted of 20,729 subjects without either COPD or T2DM. The control group was matched with the cases for sex, age, and index year (the year that the patient was diagnosed with COPD). The subjects were followed until the end of 2011.ResultsThe findings of our study showed that the risk of lung cancer was higher in the COPD group than in the non-COPD group, with adjusted hazard ratio (HR) of 5.02 [95% confidence interval (CI) = 4.23–5.94] among total case group, adjusted HR was 5.38 (95% CI = 4.52–6.40) in the cohort without T2DM and adjusted HR was 4.05 (95% CI = 3.26–5.03) in the cohort with T2DM. We observed a significantly protective effect from lung cancer (adjusted HR = 0.75, 95% CI = 0.63–0.90) of diabetic cohort than non-diabetic cohort among patients with COPD.ConclusionPatients with COPD had a significantly higher risk of developing lung cancer than healthy people. However, there was a protective effect of T2DM for lung cancer among patients with COPD. Further investigation may be needed to corroborate the mechanism or bring up reliable reasons.
Highlights
Lung cancer is the most common cancer in terms of both incidence and mortality worldwide
Chi-square test compared to total chronic obstructive pulmonary disease (COPD); #:Two sample t-test; `:Fisher exact test {The urbanization level was categorized by the population density of the residential area into 4 levels, with level 1 as the most urbanized and level 4 as the least urbanized. &NTD: New Taiwan dollar
The total COPD cohort, the COPD without type 2 diabetes mellitus (T2DM) cohort, and COPD with T2DM cohort
Summary
Lung cancer is the most common cancer in terms of both incidence and mortality worldwide. Lung cancer is the seventh most common cause of cancer deaths worldwide in never smokers [4]. Chronic obstructive pulmonary disease (COPD) is known as a persistent airflow limitation that is usually progressive and associated with an enhanced chronic inflammatory response in the airways [5]. It is the fourth leading cause of death worldwide, with a reported prevalence rates between 5% and 13% [6,7,8,9]. Previous studies have suggested that chronic obstructive pulmonary disease (COPD) is an independent risk factor for lung cancer. The aim of this study was to evaluate whether COPD with or without type 2 diabetes mellitus (T2DM) influences the risk of developing lung cancer
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