Impact of detection bias on the risk of gastrointestinal cancer and its subsites in type 2 diabetes mellitus

R G P J de Jong; A M Burden; S de Kort; M P P van Herk-Sukel; P A J Vissers; P.K.C. Janssen; H R Haak; A A M Masclee; F de Vries; M L G Janssen-Heijnen

doi:10.1016/j.ejca.2017.03.039

Impact of detection bias on the risk of gastrointestinal cancer and its subsites in type 2 diabetes mellitus

R G P J de Jong
, A M Burden
, S de Kort
, M P P van Herk-Sukel
, P A J Vissers
, P.K.C. Janssen
, H R Haak
, A A M Masclee
, F de Vries
, M L G Janssen-Heijnen

Department of Internal Medicine, VieCuri Medical Centre, Venlo, The Netherlands; Department of Internal Medicine, Division of Gastroenterology and Hepatology, GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Maastricht, The Netherlands. Electronic address: [email protected].
Maastricht University Medical Centre
PHARMO Institute for Drug Outcomes Research, Utrecht, The Netherlands.
Department of Research, Netherlands Comprehensive Cancer Organization, Utrecht, The Netherlands.
Department of Internal Medicine, Máxima Medical Centre Eindhoven, Eindhoven, The Netherlands; Department of Internal Medicine, Division of General Internal Medicine, Maastricht University Medical Centre+, Maastricht, The Netherlands; Department of Health Services Research, CAPHRI School for Public Health and Primary Care, Maastricht University Medical Centre+, Maastricht, The Netherlands.
Viecuri Medical Centre

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

BACKGROUND: Type 2 diabetes mellitus (T2DM) may be a risk factor for gastrointestinal (GI) cancers, but variations in study designs of observational studies may have yielded biased results due to detection bias. Furthermore, differences in risk for GI cancer subsites have not been extensively evaluated. We aimed to determine the risk of GI cancer and its subsites in patients with T2DM and how it is affected by detection bias.

METHODS: A matched cohort study was performed using the NCR-PHARMO database. New-users of ≥1 non-insulin anti-diabetic drug during 1998-2011 were matched with non-diabetic controls by year of birth, sex, and time between database entry and index. Cox regression analyses were performed with and without lag-period to estimate hazard ratios (HRs) for GI cancer and its subsites. Covariables included age, sex, use of other drugs and history of hospitalisation.

RESULTS: An increased risk of GI cancer was observed in T2DM patients (HR 1.5, 95% confidence interval [CI] 1.3-1.7) compared with controls, which was attenuated in the 1-year lagged analysis (HR 1.4, 95% CI 1.2-1.7). Stratified by subsite, statistically significant increased risks of pancreatic (HR 4.7, 95% CI 3.1-7.2), extrahepatic bile duct (HR 4.2, 95% CI 1.5-11.8) and distal colon cancer (HR 1.5, 95% CI 1.1-2.1) were found, which remained statistically significantly increased in the lagged analysis.

CONCLUSIONS: T2DM patients had a 40% increased risk of GI cancer. Increased GI cancer risks tended to be weaker when reducing detection bias by applying a 1-year lag-period. Future observational studies should therefore include sensitivity analyses in which this bias is minimised.

Original language	English
Pages (from-to)	61-71
Number of pages	11
Journal	European Journal of Cancer
Volume	79
DOIs	https://doi.org/10.1016/j.ejca.2017.03.039
Publication status	Published - Jul 2017

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 3 Good Health and Well-being

Keywords

Gastrointestinal cancer
Epidemiology
Type 2 diabetes mellitus
Cancer registry
Risk factors
Population based
Cohort study

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10.1016/j.ejca.2017.03.039

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Cite this

de Jong, R. G. P. J., Burden, A. M., de Kort, S., van Herk-Sukel, M. P. P., Vissers, P. A. J., Janssen, P. K. C., Haak, H. R., Masclee, A. A. M., de Vries, F., & Janssen-Heijnen, M. L. G. (2017). Impact of detection bias on the risk of gastrointestinal cancer and its subsites in type 2 diabetes mellitus. European Journal of Cancer, 79, 61-71. https://doi.org/10.1016/j.ejca.2017.03.039

@article{8956ef78e69e48e5b83c6514ffa4ee1b,

title = "Impact of detection bias on the risk of gastrointestinal cancer and its subsites in type 2 diabetes mellitus",

abstract = "BACKGROUND: Type 2 diabetes mellitus (T2DM) may be a risk factor for gastrointestinal (GI) cancers, but variations in study designs of observational studies may have yielded biased results due to detection bias. Furthermore, differences in risk for GI cancer subsites have not been extensively evaluated. We aimed to determine the risk of GI cancer and its subsites in patients with T2DM and how it is affected by detection bias.METHODS: A matched cohort study was performed using the NCR-PHARMO database. New-users of ≥1 non-insulin anti-diabetic drug during 1998-2011 were matched with non-diabetic controls by year of birth, sex, and time between database entry and index. Cox regression analyses were performed with and without lag-period to estimate hazard ratios (HRs) for GI cancer and its subsites. Covariables included age, sex, use of other drugs and history of hospitalisation.RESULTS: An increased risk of GI cancer was observed in T2DM patients (HR 1.5, 95\% confidence interval [CI] 1.3-1.7) compared with controls, which was attenuated in the 1-year lagged analysis (HR 1.4, 95\% CI 1.2-1.7). Stratified by subsite, statistically significant increased risks of pancreatic (HR 4.7, 95\% CI 3.1-7.2), extrahepatic bile duct (HR 4.2, 95\% CI 1.5-11.8) and distal colon cancer (HR 1.5, 95\% CI 1.1-2.1) were found, which remained statistically significantly increased in the lagged analysis.CONCLUSIONS: T2DM patients had a 40\% increased risk of GI cancer. Increased GI cancer risks tended to be weaker when reducing detection bias by applying a 1-year lag-period. Future observational studies should therefore include sensitivity analyses in which this bias is minimised.",

keywords = "Gastrointestinal cancer, Epidemiology, Type 2 diabetes mellitus, Cancer registry, Risk factors, Population based, Cohort study",

author = "\{de Jong\}, \{R G P J\} and Burden, \{A M\} and \{de Kort\}, S and \{van Herk-Sukel\}, \{M P P\} and Vissers, \{P A J\} and P.K.C. Janssen and Haak, \{H R\} and Masclee, \{A A M\} and \{de Vries\}, F and Janssen-Heijnen, \{M L G\}",

year = "2017",

month = jul,

doi = "10.1016/j.ejca.2017.03.039",

language = "English",

volume = "79",

pages = "61--71",

journal = "European Journal of Cancer",

issn = "0959-8049",

publisher = "Elsevier Ltd",

}

TY - JOUR

T1 - Impact of detection bias on the risk of gastrointestinal cancer and its subsites in type 2 diabetes mellitus

AU - de Jong, R G P J

AU - Burden, A M

AU - de Kort, S

AU - van Herk-Sukel, M P P

AU - Vissers, P A J

AU - Janssen, P.K.C.

AU - Haak, H R

AU - Masclee, A A M

AU - de Vries, F

AU - Janssen-Heijnen, M L G

PY - 2017/7

Y1 - 2017/7

N2 - BACKGROUND: Type 2 diabetes mellitus (T2DM) may be a risk factor for gastrointestinal (GI) cancers, but variations in study designs of observational studies may have yielded biased results due to detection bias. Furthermore, differences in risk for GI cancer subsites have not been extensively evaluated. We aimed to determine the risk of GI cancer and its subsites in patients with T2DM and how it is affected by detection bias.METHODS: A matched cohort study was performed using the NCR-PHARMO database. New-users of ≥1 non-insulin anti-diabetic drug during 1998-2011 were matched with non-diabetic controls by year of birth, sex, and time between database entry and index. Cox regression analyses were performed with and without lag-period to estimate hazard ratios (HRs) for GI cancer and its subsites. Covariables included age, sex, use of other drugs and history of hospitalisation.RESULTS: An increased risk of GI cancer was observed in T2DM patients (HR 1.5, 95% confidence interval [CI] 1.3-1.7) compared with controls, which was attenuated in the 1-year lagged analysis (HR 1.4, 95% CI 1.2-1.7). Stratified by subsite, statistically significant increased risks of pancreatic (HR 4.7, 95% CI 3.1-7.2), extrahepatic bile duct (HR 4.2, 95% CI 1.5-11.8) and distal colon cancer (HR 1.5, 95% CI 1.1-2.1) were found, which remained statistically significantly increased in the lagged analysis.CONCLUSIONS: T2DM patients had a 40% increased risk of GI cancer. Increased GI cancer risks tended to be weaker when reducing detection bias by applying a 1-year lag-period. Future observational studies should therefore include sensitivity analyses in which this bias is minimised.

AB - BACKGROUND: Type 2 diabetes mellitus (T2DM) may be a risk factor for gastrointestinal (GI) cancers, but variations in study designs of observational studies may have yielded biased results due to detection bias. Furthermore, differences in risk for GI cancer subsites have not been extensively evaluated. We aimed to determine the risk of GI cancer and its subsites in patients with T2DM and how it is affected by detection bias.METHODS: A matched cohort study was performed using the NCR-PHARMO database. New-users of ≥1 non-insulin anti-diabetic drug during 1998-2011 were matched with non-diabetic controls by year of birth, sex, and time between database entry and index. Cox regression analyses were performed with and without lag-period to estimate hazard ratios (HRs) for GI cancer and its subsites. Covariables included age, sex, use of other drugs and history of hospitalisation.RESULTS: An increased risk of GI cancer was observed in T2DM patients (HR 1.5, 95% confidence interval [CI] 1.3-1.7) compared with controls, which was attenuated in the 1-year lagged analysis (HR 1.4, 95% CI 1.2-1.7). Stratified by subsite, statistically significant increased risks of pancreatic (HR 4.7, 95% CI 3.1-7.2), extrahepatic bile duct (HR 4.2, 95% CI 1.5-11.8) and distal colon cancer (HR 1.5, 95% CI 1.1-2.1) were found, which remained statistically significantly increased in the lagged analysis.CONCLUSIONS: T2DM patients had a 40% increased risk of GI cancer. Increased GI cancer risks tended to be weaker when reducing detection bias by applying a 1-year lag-period. Future observational studies should therefore include sensitivity analyses in which this bias is minimised.

KW - Gastrointestinal cancer

KW - Epidemiology

KW - Type 2 diabetes mellitus

KW - Cancer registry

KW - Risk factors

KW - Population based

KW - Cohort study

U2 - 10.1016/j.ejca.2017.03.039

DO - 10.1016/j.ejca.2017.03.039

M3 - Article

C2 - 28463757

SN - 0959-8049

VL - 79

SP - 61

EP - 71

JO - European Journal of Cancer

JF - European Journal of Cancer

ER -

Impact of detection bias on the risk of gastrointestinal cancer and its subsites in type 2 diabetes mellitus

Abstract

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Keywords

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