Metformin usage and the risk of colorectal cancer: a national cohort study
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ORIGINAL ARTICLE
Metformin usage and the risk of colorectal cancer: a national cohort study Jae-woo Lee 1 & Eun-A Choi 2 & Ye-Seul Kim 1 & Yonghwan Kim 1 & Hyo-Sun You 1 & Ye-Eun Han 2 & Hyeong-Seop Kim 2 & Yoon-Jong Bae 2 & Joungyoun Kim 2 & Hee-Taik Kang 1,3 Accepted: 17 September 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose This study aimed to investigate the association between metformin usage and the risk of colorectal cancer (CRC) using data from the Korean National Health Insurance Service–National Health Screening Cohort database. Methods Data from the NHIS-HEALS cohort between 2002 and 2015 were longitudinally analyzed. Subjects were divided into three groups: metformin non-users with diabetes mellitus (DM), metformin users with DM, and no DM group. CRC was defined using the ICD-10 code (C18.0-C20.0) at the time of admission. Cox proportional hazard regression models were adopted after stepwise adjustment for confounders to investigate the association between metformin usage and colorectal cancer risk. Results During the follow-up period, of the total 323,430 participants, 2341 (1.33%) of the 175,495 males and 1204 (0.81%) of the 147,935 females were newly diagnosed with CRC. The estimated cumulative incidence of CRC was significantly different among the three groups based on Kaplan-Meier’s survival curve (p values < 0.05 in both sexes). Compared with metformin nonusers, hazard ratios (95% CIs) of metformin users and the no DM group were 0.66 (0.51–0.85) and 0.72 (0.61–0.85) in males and 0.59 (0.37–0.92) and 0.93 (0.66–1.29) in females, respectively, after being fully adjusted. Conclusions Metformin users with diabetes appear to have a significantly lower risk of CRC compared with metformin nonusers. Keywords Metformin . Colorectal cancer . Diabetes . Kaplan-Meier estimate . Cox proportional hazard models
Jae-woo Lee and Eun-A Choi; These co-first authors contributed equally to this work. Hee-Taik Kang and Joungyoun Kim; These co-corresponding authors contributed equally to this work. Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00384-020-03765-x) contains supplementary material, which is available to authorized users. * Joungyoun Kim [email protected] * Hee-Taik Kang [email protected] 1
Department of Family Medicine, Chungbuk National University Hospital, Cheongju, Republic of Korea
2
Department of Information & Statistics, Chungbuk National University, 1 Chungdae-ro, Seowon-gu, Cheongju, Chungbuk 28644, Republic of Korea
3
Department of Family Medicine, Chungbuk National University College of Medicine, 1 Chungdae-ro, Seowon-gu, Cheongju, Chungcheongbuk-do 28644, Republic of Korea
Introduction Colorectal cancer (CRC) is the third most common cancer and the second cause of cancer deaths worldwide, accounting for over 1.8 million new cases and about 880,000 deaths in 2018 [1]. The incidence and mortality rates due to CRC are increasing in many low-income and middle-income countries [2]. In Korea, malig
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