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Epidemiology

Associations of diabetes and mortality among colorectal cancer patients from the Southern Community Cohort Study

British Journal of Cancer volume 131, pages 1050–1059 (2024)Cite this article

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Abstract

Background

We investigated associations between diabetes and mortality among participants with incident colorectal cancer (CRC) from the Southern Community Cohort Study.

Methods

Participants (73% non-Hispanic Black; 60% income < $15,000) were recruited between 2002–2009. Diabetes was self-reported at enrollment and follow-up surveys at approximately 5-year intervals. Incident CRC and mortality were identified via state registries and the National Death Index. Proportional hazards models calculated associations between diabetes with overall, CRC-specific mortality among 1059 participants with incident CRC.

Results

Diabetes prior to diagnosis is associated with elevated overall (hazard ratio [95% confidence interval]: (1.46[1.22–1.75]), and CRC-specific mortality (1.36[1.06–1.74])) after adjustment for tumor stage. For non-Hispanic Black and non-Hispanic White participants, consistent associations were observed for overall (1.35[1.10–1.66] vs. 1.89[1.31–2.72], respectively, p-interaction = 0.11) and CRC-specific mortality (1.30[0.99–1.71] vs. 1.77[1.06–2.95], respectively, p-interaction = 0.28). For individuals with incomes <$15,000/year, associations with overall (1.44[1.15–1.79]) and CRC-specific mortality (1.28[0.94–1.73]) were similar to the full sample. Associations with overall (1.71[1.37–2.13]) and CRC-specific mortality (1.65[1.22–2.22]) were highest for diabetes ≥ 10 years at diagnosis.

Conclusions

Pre-diagnosis diabetes is associated with higher mortality among participants with incident CRC from a predominantly non-Hispanic Black cohort with lower socioeconomic status. The higher prevalence of diabetes in this population may contribute to racial disparities in CRC mortality.

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Fig. 1: Kaplan–Meier curves for overall mortality.
Fig. 2: Associations between self-reported diabetes and mortality outcomes among participants with incident colorectal cancer, stratified by demographic risk factors for mortality.

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Data availability

The data that support the findings of this study are available from The Southern Community Cohort Study but restrictions apply to the availability of these data, which were used under license for the current study, and so are not publicly available. Data are however available from the authors upon reasonable request and with permission of The Southern Community Cohort Study.

Code availability

Our SAS program is available upon reasonable request to the corresponding author.

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Acknowledgements

Data on SCCS cancer cases used in this publication were provided by the Alabama Statewide Cancer Registry; Kentucky Cancer Registry, Lexington, KY; Tennessee Department of Health, Office of Cancer Surveillance; Florida Cancer Data System; North Carolina Central Cancer Registry, North Carolina Division of Public Health; Georgia Comprehensive Cancer Registry; Louisiana Tumor Registry; Mississippi Cancer Registry; South Carolina Central Cancer Registry; Virginia Department of Health, Virginia Cancer Registry; Arkansas Department of Health, Cancer Registry, 4815 W. Markham, Little Rock, AR 72205. The Arkansas Central Cancer Registry is fully funded by a grant from National Program of Cancer Registries, Centers for Disease Control and Prevention (CDC). Data on SCCS cancer cases from Mississippi were collected by the Mississippi Cancer Registry which participates in the National Program of Cancer Registries (NPCR) of the Centers for Disease Control and Prevention (CDC). The contents of this publication are solely the responsibility of the authors and do not necessarily represent the official views of the CDC or the Mississippi Cancer Registry. Cancer data for SCCS cancer cases from West Virginia have been provided by the West Virginia Cancer Registry. The opinions expressed are those of the authors and do not necessarily represent those of the CDC or the West Virginia Cancer Registry. Data collection and sample preparation were performed by the Survey and Biospecimen Shared Resource which is supported in part by the Vanderbilt‐Ingram Cancer Center (P30CA68485).

Funding

This work was supported by the National Cancer Institute at the National Institutes of Health (grant number R01 CA255318 to S Warren Andersen); the University of Wisconsin-Madison, Office of Vice Chancellor for Research and Graduate Education with funding from the Wisconsin Alumni Research Foundation and the University of Wisconsin Carbone Cancer (grant number P30 CA014520 to HH Bailey). The Southern Community Cohort Study (SCCS) is supported by the National Cancer Institute at the National Institutes of Health (grant number U01 CA202979 to W Zheng), including special allocations from the American Recovery and Reinvestment Act (grant number 3R01 CA092447‐08S1 to WJ Blot). The funding source had no role in the study design, in the collection, analysis, and interpretation of data, or in the decision to submit the article for publication.

Author information

Authors and Affiliations

  1. University of Wisconsin Carbone Cancer Center, Madison, WI, 53726, USA

    Thomas Lawler, Zoe L. Walts, Lauren Giurini & Shaneda Warren Andersen

  2. Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, 60611, USA

    Elizabeth Hibler

  3. Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin-Madison, 610 Walnut St, WARF Office Building, Madison, WI, 53726, USA

    Zoe L. Walts, Lauren Giurini & Shaneda Warren Andersen

  4. International Epidemiology Field Station, Vanderbilt Institute for Clinical and Translational Research, 1455 Research Blvd.; Suite 550, Rockville, MD, 20850, USA

    Mark Steinwandel

  5. Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt-Ingram Cancer Center, Vanderbilt University School of Medicine, 2525 West End Avenue, Nashville, TN, 37203-1738, USA

    Loren Lipworth, Wei Zheng & Shaneda Warren Andersen

  6. Department of Medicine, Vanderbilt University School of Medicine, 6012 Medical Center East, 1215 21st Avenue South, Nashville, TN, 37203-1738, USA

    Harvey J. Murff

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Contributions

SWA and WZ contributed to the conceptualization, funding acquisition, resources, software, project administration and supervision of this study. TL, MS, and WZ contributed to the investigation and data collection. SWA and TL contributed to the formal analysis and methodology. MS and TL contributed to the data curation. SWA and TL contributed to visualization. TL, ZW, LG, and SWA contributed to writing the original draft. EH, LL and HM contributed to reviewing and editing the manuscript. All authors approved the final manuscript.

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Correspondence to Shaneda Warren Andersen.

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The authors declare no competing interests.

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Approval for the SCCS was granted by the Institutional Review Boards of Vanderbilt University Medical Center and Meharry Medical College. All participants provided written informed consent and all study procedures conformed to the tenets of the Declaration of Helsinki.

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Lawler, T., Hibler, E., Walts, Z.L. et al. Associations of diabetes and mortality among colorectal cancer patients from the Southern Community Cohort Study. Br J Cancer 131, 1050–1059 (2024). https://doi.org/10.1038/s41416-024-02787-4

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