Racial disparities in colorectal cancer incidence by type 2 diabetes mellitus status
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ORIGINAL PAPER
Racial disparities in colorectal cancer incidence by type 2 diabetes mellitus status Philip P. Cavicchia • Swann Arp Adams • Susan E. Steck • James R. Hussey • Jihong Liu Virginie G. Daguise´ • James R. Hebert
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Received: 12 June 2012 / Accepted: 2 November 2012 / Published online: 30 November 2012 Ó Springer Science+Business Media Dordrecht 2012
Abstract Purpose Type 2 diabetes mellitus (T2DM) prevalence has increased dramatically in the United States since the early 1970s. Though T2DM is known to be associated with colorectal cancer (CRC), information on racial differences in the relationship between T2DM and CRC is limited. Methods Using a retrospective cohort design, we compared the association between T2DM and CRC, including subsites of the colon, in African Americans (AAs) and European Americans (EAs) in South Carolina, a region with large racial disparities in rates of both diseases. A
Institutional Review Board approvals were obtained from the University of South Carolina and the South Carolina Department of Health and Environmental Control. P. P. Cavicchia S. A. Adams S. E. Steck J. R. Hebert (&) South Carolina Statewide Cancer Prevention and Control Program, University of South Carolina, 915 Greene Street, Suite 241-2, Columbia, SC 29208, USA e-mail: [email protected] P. P. Cavicchia S. A. Adams S. E. Steck J. R. Hussey J. Liu J. R. Hebert Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, 800 Sumter Street, Columbia, SC 29208, USA P. P. Cavicchia Florida Department of Health, Tallahassee, FL 32399, USA S. A. Adams College of Nursing, University of South Carolina, Columbia, SC 29208, USA V. G. Daguise´ South Carolina Department of Health and Environmental Control, Columbia, SC 29201, USA
total of 91,836 individuals who were C30 years old on 1 January 1990 and had C12 months of South Carolina Medicaid eligibility between 1 January 1990 and 31 December 1995 were included in the analyses. Cancer data from 1996 to 2007 included information on anatomic subsite. Results Subjects who had T2DM (n = 6,006) were [50 % more likely to be diagnosed with colon cancer compared to those without T2DM (n = 85,681). The association between T2DM and colon cancer was higher in AAs [odds ratio (OR) = 1.72 (95 % confidence interval: 1.21, 2.46); n = 47,984] than among EAs (OR = 1.24; 0.73, 2.11; n = 43,703). Overall, individuals with T2DM were over twice as likely to be diagnosed with in situ or local colon cancer (OR = 2.12; 1.40, 3.22; n = 191) compared to those without T2DM, with a higher likelihood among AAs (OR = 2.49; 1.52, 4.09; n = 113). Conclusions Results from a Medicaid population in a high-risk region of the United States showed an increased likelihood of CRC with T2DM and suggest a racial disparity that disfavors AAs and provides further impetus for efforts aimed at diabetes prevention in this group. Keywords Cohort study design Colorectal cancer Diabetes mellitus type 2 Health status disparities Incidence South Carol
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