Yong-Moon Mark Park, Benjamin C Amick Iii, Pearl A McElfish, Clare C Brown, Mario Schootman, Marie-Rachelle Narcisse, Seong-Su Lee, Yoon Jin Choi, Kyungdo Han
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We determined income levels based on health insurance premiums and assessed annual income quartiles for the baseline year and the four preceding years. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated after adjusting for sociodemographic factors, CRC risk factors, and diabetes duration and treatment.</p><p><strong>Results: </strong>Persistent low income (ie, lowest income quartile) was associated with increased CRC risk (HR<sub>5 years vs 0 years</sub> 1.11; 95% CI, 1.04-1.18; P for trend = 0.004). Income declines (ie, a decrease ≥25% in income quantile) were also associated with increased CRC risk (HR<sub>≥2 vs 0 declines</sub> 1.10; 95% CI, 1.05-1.16; P for trend = 0.001). In contrast, persistent high income (ie, highest income quartile) was associated with decreased CRC risk (HR<sub>5 years vs 0 years</sub> 0.81; 95% CI, 0.73-0.89; P for trend < 0.0001), which was more pronounced for rectal cancer (HR 0.64; 95% CI, 0.53-0.78) and distal colon cancer (HR 0.70; 95% CI, 0.57-0.86).</p><p><strong>Conclusion: </strong>Our findings underscore the need for increased public policy awareness of the association between income dynamics and CRC risk in adults with T2DM.</p>","PeriodicalId":15799,"journal":{"name":"Journal of Epidemiology","volume":" ","pages":"30-38"},"PeriodicalIF":3.7000,"publicationDate":"2025-01-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11637811/pdf/","citationCount":"0","resultStr":"{\"title\":\"Income Dynamics and Risk of Colorectal Cancer in Individuals With Type 2 Diabetes: A Nationwide Population-based Cohort Study.\",\"authors\":\"Yong-Moon Mark Park, Benjamin C Amick Iii, Pearl A McElfish, Clare C Brown, Mario Schootman, Marie-Rachelle Narcisse, Seong-Su Lee, Yoon Jin Choi, Kyungdo Han\",\"doi\":\"10.2188/jea.JE20230310\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Individuals with type 2 diabetes mellitus (T2DM) have increased colorectal cancer (CRC) risk, but it is unknown whether income dynamics are associated with CRC risk in these individuals. We examined whether persistent low- or high-income and income changes are associated with CRC risk in non-elderly adults with T2DM.</p><p><strong>Methods: </strong>Using nationally representative data from the Korean Health Insurance Service database, 1,909,492 adults aged 30 to 64 years with T2DM and no history of cancer were included between 2009 and 2012 (median follow-up of 7.8 years). We determined income levels based on health insurance premiums and assessed annual income quartiles for the baseline year and the four preceding years. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated after adjusting for sociodemographic factors, CRC risk factors, and diabetes duration and treatment.</p><p><strong>Results: </strong>Persistent low income (ie, lowest income quartile) was associated with increased CRC risk (HR<sub>5 years vs 0 years</sub> 1.11; 95% CI, 1.04-1.18; P for trend = 0.004). Income declines (ie, a decrease ≥25% in income quantile) were also associated with increased CRC risk (HR<sub>≥2 vs 0 declines</sub> 1.10; 95% CI, 1.05-1.16; P for trend = 0.001). In contrast, persistent high income (ie, highest income quartile) was associated with decreased CRC risk (HR<sub>5 years vs 0 years</sub> 0.81; 95% CI, 0.73-0.89; P for trend < 0.0001), which was more pronounced for rectal cancer (HR 0.64; 95% CI, 0.53-0.78) and distal colon cancer (HR 0.70; 95% CI, 0.57-0.86).</p><p><strong>Conclusion: </strong>Our findings underscore the need for increased public policy awareness of the association between income dynamics and CRC risk in adults with T2DM.</p>\",\"PeriodicalId\":15799,\"journal\":{\"name\":\"Journal of Epidemiology\",\"volume\":\" \",\"pages\":\"30-38\"},\"PeriodicalIF\":3.7000,\"publicationDate\":\"2025-01-05\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11637811/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Epidemiology\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.2188/jea.JE20230310\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2024/11/30 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q1\",\"JCRName\":\"PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Epidemiology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.2188/jea.JE20230310","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/11/30 0:00:00","PubModel":"Epub","JCR":"Q1","JCRName":"PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH","Score":null,"Total":0}
引用次数: 0
摘要
背景:2 型糖尿病(T2D)患者患结直肠癌(CRC)的风险增加,但收入动态是否与这些患者的 CRC 风险相关尚不清楚。我们研究了持续的低收入或高收入以及收入变化是否与患有 T2D 的非老年人的 CRC 风险相关:我们利用韩国健康保险服务数据库中具有全国代表性的数据,纳入了 2009 年至 2012 年间(中位数随访时间为 7.8 年)1,909,492 名年龄在 30 岁至 64 岁之间、患有 T2D 且无癌症病史的成年人。我们根据医疗保险费确定收入水平,并评估基线年及之前四年的年收入四分位数。在对社会人口因素、CRC风险因素、糖尿病病程和治疗进行调整后,对危险比(HRs)和95%置信区间(CIs)进行了估计:持续低收入(即最低收入四分位数)与 CRC 风险增加有关(HRn=5 年 vs. n=0 年 1.11,95% CI 1.04-1.18;趋势 P=0.004)。收入下降(即收入数量级下降≥25%)也与 CRC 风险增加有关(HR≥2 vs. 0 下降 1.10,95% CI 1.05-1.16;P 为趋势=0.001)。相比之下,持续高收入(即最高收入四分位数)与 CRC 风险降低有关(HRn=5 年 vs. n=0 年 0.81,95% CI 0.73-0.89;p 为趋势):我们的研究结果表明,有必要提高公共政策对患有 T2D 的成年人的收入动态与 CRC 风险之间关系的认识。
Income Dynamics and Risk of Colorectal Cancer in Individuals With Type 2 Diabetes: A Nationwide Population-based Cohort Study.
Background: Individuals with type 2 diabetes mellitus (T2DM) have increased colorectal cancer (CRC) risk, but it is unknown whether income dynamics are associated with CRC risk in these individuals. We examined whether persistent low- or high-income and income changes are associated with CRC risk in non-elderly adults with T2DM.
Methods: Using nationally representative data from the Korean Health Insurance Service database, 1,909,492 adults aged 30 to 64 years with T2DM and no history of cancer were included between 2009 and 2012 (median follow-up of 7.8 years). We determined income levels based on health insurance premiums and assessed annual income quartiles for the baseline year and the four preceding years. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated after adjusting for sociodemographic factors, CRC risk factors, and diabetes duration and treatment.
Results: Persistent low income (ie, lowest income quartile) was associated with increased CRC risk (HR5 years vs 0 years 1.11; 95% CI, 1.04-1.18; P for trend = 0.004). Income declines (ie, a decrease ≥25% in income quantile) were also associated with increased CRC risk (HR≥2 vs 0 declines 1.10; 95% CI, 1.05-1.16; P for trend = 0.001). In contrast, persistent high income (ie, highest income quartile) was associated with decreased CRC risk (HR5 years vs 0 years 0.81; 95% CI, 0.73-0.89; P for trend < 0.0001), which was more pronounced for rectal cancer (HR 0.64; 95% CI, 0.53-0.78) and distal colon cancer (HR 0.70; 95% CI, 0.57-0.86).
Conclusion: Our findings underscore the need for increased public policy awareness of the association between income dynamics and CRC risk in adults with T2DM.
期刊介绍:
The Journal of Epidemiology is the official open access scientific journal of the Japan Epidemiological Association. The Journal publishes a broad range of original research on epidemiology as it relates to human health, and aims to promote communication among those engaged in the field of epidemiological research and those who use epidemiological findings.