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Dis Esophagus. 2016 Oct;29(7):747-751. doi: 10.1111/dote.12402. Epub 2015 Oct 12.

Association between diabetes and esophageal cancer, independent of obesity, in the United States Veterans Affairs population.

Author information

1
Surgery Service, Central Texas Veterans Health Care System, Temple, TX, USA.
2
Department of Surgery, Scott & White Healthcare, Temple, TX, USA.
3
Center for Applied Health Research, jointly sponsored by Central Texas Veterans Health Care System and by Scott & White Healthcare, Temple, TX, USA.
4
Texas A&M Health Science Center, College Station, TX, USA.
5
Health Services Research & Development, South Texas Veterans Health Care System, San Antonio, TX, USA.
6
Surgery Service, Central Texas Veterans Health Care System, Temple, TX, USA. philip.a.rascoe@uth.tmc.edu.
7
Department of Surgery, Scott & White Healthcare, Temple, TX, USA. philip.a.rascoe@uth.tmc.edu.

Abstract

In the past 30 years, the incidence of esophageal adenocarcinoma (EAC) has increased more rapidly than any other cancer in the United States. The prevalence of obesity and diabetes mellitus has drastically increased as well. We explored the potential association between obesity, diabetes mellitus, and EAC. By means of retrospective interrogation of an administrative database from fiscal year 2005-2009, we identified two cohorts. The cancer cohort was defined as patients with adenocarcinoma of the distal esophagus or gastric cardia. The comparison cohort contained patients with gastroesophageal reflux disorder (GERD; diagnosis coupled with a procedure code for fundoplication). Patient data, including demographic measures, diagnoses of obesity, diabetes mellitus, dyslipidemia, alcohol abuse, and nicotine dependence were examined. A logistic regression model identified risk factors for development of EAC. The sample included 2,836 patients identified as having either EAC (1,704) or fundoplication with GERD (1,132). Although slightly higher percentages of the benign cohort were obese, the cancer cohort had more diabetics (30.8% vs. 14.8%; chi-square = 94.5; P < 0.0001). In a logistic regression analysis adjusting for comorbidity and lifestyle factors, diagnosis of diabetes mellitus was significantly associated with esophageal cancer as opposed to GERD without cancer (OR = 2.2; 95% confidence interval [CI] 1.7-2.8). Nicotine dependence was also identified as a risk factor (OR = 1.7; 95% CI 1.4-2.0). We identified a potential association between diabetes mellitus and adenocarcinoma of the esophagus or gastric cardia. This association appears to be independent of obesity. Additionally, nicotine dependence was identified as a risk factor for EAC.

KEYWORDS:

adenocarcinoma; diabetes; epidemiology; esophageal cancer

PMID:
26455587
DOI:
10.1111/dote.12402
[Indexed for MEDLINE]

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