Postpancreatitis Diabetes Confers Higher Risk for Pancreatic Cancer Than Type 2 Diabetes: Results From a Nationwide Cancer Registry

Epidemiology/Health Services Research

Diabetes Care 2020 Sep; 43(9): 2106-2112. https://doi.org/10.2337/dc20-0207

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Figure 1
Selection process of the study groups.
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Figure 2
Probability of developing pancreatic cancer in the study groups. The analysis was adjusted for age, sex, ethnicity, social deprivation index, alcohol abuse, tobacco smoking, history of gallstones, cholecystectomy, and Charlson comorbidity index.

Table 1

Characteristics of the study groups

	T2D	PAN	T2D-PAN	PPDM	P
n	131,368	6,933	1,051	491
Age (years), mean (SD)	70.4 (9.4)	70.7 (10.1)	68.0 (8.2)	68.9 (9.4)	<0.001
Men, n (%)	66,866 (50.9)	3,365 (48.5)	614 (58.4)	295 (60.1)	<0.001
Ethnicity, n (%)
European	85,287 (64.9)	5,664 (81.7)	606 (57.7)	371 (75.6)	<0.001
Māori or Pacific Islander	27,565 (21.0)	720 (10.4)	310 (29.5)	85 (17.3)
Asian	10,151 (7.7)	212 (3.1)	71 (6.8)	20 (4.1)
Other	8,365 (6.4)	337 (4.9)	64 (6.1)	15 (3.1)
Social deprivation index, n (%)
Quartile 1	28,816 (21.9)	1,857 (26.8)	184 (17.5)	96 (19.6)	<0.001
Quartile 2	36,750 (28.0)	2,062 (29.7)	268 (25.5)	139 (28.3)
Quartile 3	15,968 (12.2)	886 (12.8)	145 (13.8)	74 (15.1)
Quartile 4	38,438 (29.3)	1,592 (23.0)	352 (33.5)	145 (29.5)
Missing	11,396 (8.7)	536 (7.7)	102 (9.7)	37 (7.5)
Alcohol abuse, n (%)	2,692 (2.1)	460 (6.6)	85 (8.1)	55 (11.2)	<0.001
Tobacco smoking, n (%)	66,935 (51.0)	2,791 (40.3)	721 (68.6)	323 (65.8)	<0.001
History of gallstones, n (%)	35 (0.0)	60 (0.9)	138 (13.1)	58 (11.8)	<0.001
Cholecystectomy, n (%)	15 (0.0)	9 (0.1)	37 (3.5)	33 (6.7)	<0.001
Charlson comorbidity index, n (%)
0	0 (0.0)	5,594 (80.7)	0 (0.0)	0 (0.0)	<0.001
1	61,437 (46.8)	757 (10.9)	549 (52.2)	220 (44.8)
2	21,993 (16.7)	323 (4.7)	177 (16.8)	75 (15.3)
≥3	47,938 (36.5)	259 (3.7)	325 (30.9)	196 (39.9)

P values were from one-way ANOVA (for age) and χ² tests (for the other variables) between the four groups. Tobacco smoking and alcohol abuse were identified throughout the entire observation period.

Table 2

Risk of pancreatic cancer in the study groups

	Person-years	Crude HR (95% CI)	Adjusted HR (95% CI)
Overall pancreatic cancer
T2D	694,503	1.00	1.00
PAN	35,313	3.63 (3.03–4.36)	4.86 (3.38–6.99)
T2D-PAN	4,062	5.03 (3.35–7.55)	5.35 (3.52–8.14)
PPDM	1,662	7.17 (4.30–11.96)	6.94 (4.09–11.77)
Resected pancreatic cancer
T2D	694,503	1.00	1.00
PAN	35,313	10.97 (6.16–19.54)	18.88 (6.51–54.75)
T2D-PAN	4,062	17.97 (6.35–50.90)	16.11 (5.48–47.36)
PPDM	1,662	19.45 (4.66–81.26)	17.66 (4.11–75.89)
Unresected pancreatic cancer
T2D	694,503	1.00	1.00
PAN	35,313	3.51 (2.66–4.63)	3.41 (1.86–6.26)
T2D-PAN	4,062	2.84 (1.27–6.36)	2.87 (1.24–6.60)
PPDM	1,662	6.53 (2.91–14.65)	5.70 (2.42–13.45)
Metastatic pancreatic cancer
T2D	694,503	1.00	1.00
PAN	35,313	3.12 (2.37–4.09)	5.32 (3.21–8.83)
T2D-PAN	4,062	5.77 (3.38–9.83)	6.53 (3.78–11.28)
PPDM	1,662	6.57 (3.11–13.88)	6.80 (3.17–14.61)

Adjusted HRs were from multivariable Cox regression models including age, sex, ethnicity, social deprivation index, alcohol abuse, tobacco smoking, history of gallstones, history of cholecystectomy, and Charlson comorbidity index.