Accepted for/Published in: JMIR Public Health and Surveillance
Date Submitted: May 31, 2024
Date Accepted: Feb 18, 2025
The interactions among factors associated with the risk of colorectal cancer among type 2 diabetes patients: a survival tree analysis
ABSTRACT
Background:
Colorectal cancer (CRC) and diabetes share many common lifestyle risk factors, such as obesity. However, it remains largely unknown how different factors interact to influence the risk of CRC among diabetes patients.
Objective:
This study aims to identify the interaction patterns among factors associated with the risk of CRC among diabetes patients.
Methods:
This is a retrospective cohort study conducted using electronic health records of Hong Kong. Patients who received diabetes care in general outpatient clinics between 2010 and 2019 without cancer history were included and followed up until December 2019. Conditional inference survival tree was applied to examine the interaction patterns among factors associated with the risk of CRC.
Results:
A total of 386,325 patients were included. During a median follow-up of 6.2 years, 4,199 patients developed CRC. Patients were first partitioned into four age groups by increased levels of CRC risk (≤54 vs 55 to 61 vs 62 to 73 vs >73 years). Among patients aged 54 years above, male sex was the dominant risk factor for CRC within each age stratum and the associations lessened with age. Abdominal obesity (waist-to-hip ratio >0.95) and longer duration of diabetes (median: 12 vs 4 years) were identified as key risk factor for CRC among males aged between 62 to 73 years and females aged 73 years above respectively.
Conclusions:
This study shows the interaction patterns among age, sex, waist-to-hip ratio, and duration of diabetes on the risk of CRC among diabetes patients. Findings of the study may help identify target groups for public health intervention strategies. Clinical Trial: NA
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