Increased Lung Cancer Risk among Diabetic Patients-a Nationwide Population-Based Study

糖尿病患者有較高肺癌的風險－以全國人口為對象之研究

李曉彤(Hsiao-Tung Lee) ； 賴志政(Chih-Cheng Lai) ； 陳衛洲(Wei-Chou Chen) ； 吳詩慧(Shih-Hui Wu) ； 林恒毅(Hen-I Lin)

《輔仁醫學期刊》 14卷4期 (2016/12) Pp. 175-184

https://doi.org/10.3966/181020932016121404001

摘要

Objective: This retrospective study was conducted to examine the relationship between diabetes mellitus (DM) and lung cancer by using Taiwan's nationwide, population-based database. Methods: The National Health Insurance (NHI) is a mandatory universal health insurance program, offering comprehensive medical care coverage to all Taiwanese residents. A multistage stratified systematic sampling design was used. We searched the Longitudinal Health Insurance Database 2005 (LHID2005) for the source population during 2000-2004 to identify the patients with diabetes or lung cancer. Results: A total of 44,893 cases of type 2 diabetes were defined as study group, and a total of 898,602 subjects were identified as the control group. The cumulative incidence markedly increased with age in either the diabetic or non-diabetic patients. Risk ratio analysis showed that diabetic patients had a higher risk than non-diabetic patients in each age group, and both genders. The highest age-specific risk ratio was observed in diabetic male with age ＜ 40 years (RR=6.8). Adjusted hazard ratio (HR) for the 4-year follow-up period on the likelihood of developing lung cancer is 1.312 (95%CI=1.20-1.44). Conclusions: This study demonstrates the incidence of lung cancer is increasing with age in Taiwan, and a positive association between diabetes and subsequent lung cancer, which is much more remarkable in the age of ＜ 40 years.

關鍵字

diabetes mellitus ； lung cancer ； population-based study ； epidemiology

並列摘要

目的：這項回朔性研究是利用台灣全民健保資料庫建立的研究族群，探究第二型糖尿病（Type II DM）和肺癌間的相關性。方法：全民健康保險（NHI）是一項強制性的全民醫療保險計畫，提供所有台灣居民全面的醫療服務。本研究使用多階段分層系統抽樣產生的抽樣檔—2005年承保抽樣歸人檔（LHID2005），並從LHID2005定義出2000-2004年有糖尿病或肺癌患者。結果：本研究包含44,893位糖尿病病例組及898,602位對照組。不論是糖尿病或非糖尿病族群，肺癌累積發生率均隨著年齡有顯著增加趨勢。危險比值（risk ratio）分析顯示不論在哪個年齡組或性別，糖尿病患者相較於非糖尿病患者有較高的風險罹患肺癌。危險比值最高的是年齡＜40歲的男性糖尿病患者（RR=6.8）。利用Cox proportional hazards regression model調整共變項後的糖尿病患者罹患肺癌的風險相較於非糖尿病患者之危險比（HR）為1.31倍（95%CI為1.20-1.44）。結論：根據全民健保資料庫的追蹤研究顯示，在台灣肺癌的發生率隨著年齡有增加的趨勢，且糖尿病和後續肺癌的發生有顯著正相關存在，特別是在低於40歲的族群有最高的風險。

並列關鍵字

糖尿病 ； 肺癌 ； 族群研究 ； 流行病學