TITLE:
Correlation between diabetes prevalence and subsequent cancer mortality in North Carolina counties
AUTHORS:
John G. Spangler, Julienne Kirk
KEYWORDS:
Diabetes Mellitus; Cancer; Mortality; North Carolina
JOURNAL NAME:
Journal of Diabetes Mellitus,
Vol.4 No.1,
January
8,
2014
ABSTRACT: Worldwide, over 250 million people live with
diabetes mellitus, a disease which has been described as an epidemic. While
much is known about the cardiovascular risks associated with this condition,
its association with cancer has been less appreciated at the population level.
This study assessed the relationship between colo-rectal, breast and prostate
cancer mortality, and diabetes prevalence measured years earlier at the county
level in the 100 counties of North Carolina. Methods: County level data were obtained
from the 2000 US Census, the Centers for Disease Control and Prevention, and
the North Carolina State Center for Health Statistics. The 2004 diabetes
prevalence data by county and county level mortality from 2005 to 2009 for colorectal,
breast and prostate cancer mortality were analyzed descriptively. Then
multivariate linear regression was carried out to evaluate the contribution of
pre-existing diabetes prevalence to cancer mortality, controlling county level
covariates. Results: Average North Carolina county level prevalence of diabetes
mellitus in 2004 (9%) was higher than the average prevalence of diabetes
nationally in 2004 (7%). Mortality rates for breast, colorectal and prostate
cancers at the county level were also higher than those nationally. In
multivariate analysis, county level 2005-2009 total cancer mortality as well as
mortality from colon and prostate cancers (but not breast cancer) correlated
with county level 2004 diabetes prevalence rates. Diabetes mellitus prevalence
in 2004 explained 31%, 34% and 42% of the variance
of mortality from prostate, colorectal and total cancers. Conclusions: These
findings support the relationship between diabetes mellitus and cancer at the
population level. Direct and indirect costs of cancer care in North Carolina in
2004 were $5.57 billion. Because diabetes explained 42% of the variance of
total county level cancer mortality, prevention and control of diabetes could
save the state over $2 billion.