Association between Any T2D and bladder cancer in the multiethnic sample stratified by sex, smoking status, alcohol consumption, and BMI. Models adjusted for pack-years smoked (0, 1–10, 11–20, 21–30, 31–40, >40), alcohol consumption (<1 drink/month, ≤1 drink/day, >1 drinks/day), sex (male, female), number of cigarettes smoked per day among smokers (5 cigarettes or less, 6–10 cigarettes, 11–20, 21–30, 31, or more), race/ethnicity (European American, African American, Japanese American, Latin American, Native Hawaiian), and reproductive factors among females. BMI (kg/m3) and smoking status (ever, never, current) were included as strata variables due to their proportional hazard violation. Categorical birthyear was also included as a strata variable to adjust for possible cohort effects. CI, confidence interval; HR, hazard ratio; P het: P-heterogeneity for likelihood ratio test for difference in association across covariate levels.
ARTICLE ABSTRACT
Research on the association between type 2 diabetes (T2D) and bladder cancer (BCA) risk among non-European ancestry populations is sparse to nonexistent, and most prior studies rely on a single baseline assessment of T2D status.
We estimated the T2D-BCA association using the Multiethnic Cohort Study of 185,059 men and women in California and Hawaii. Participants were African American, European American, Japanese American, Latin American, and Native Hawaiian, ages 45–75 years at enrollment (1993–1996). T2D was assessed by self-report at baseline, follow-up surveys, and Medicare claims. Cases were identified using Surveillance, Epidemiology and End Results Program cancer registries through 2016. Associations were estimated by race/ethnicity using Cox proportional hazards regression. Adjusted attributable fractions (AAF) and cumulative absolute risk of bladder cancer were estimated across groups.
Over an average 19.7 years of follow-up 1,890 incident bladder cancer cases were diagnosed. Time-varying T2D was associated with bladder cancer in the multiethnic sample (HR = 1.17; 95% confidence interval, 1.05–1.30); however, the HR did not differ by race/ethnicity (P = 0.85). The AAF was 4.2% in the multiethnic sample and largest among Native Hawaiians (9.8%). Absolute risk of bladder cancer among European Americans without T2D was higher than all other groups with T2D.
T2D is significantly associated with bladder cancer risk in a multiethnic sample.
Those with T2D have higher incidence of bladder cancer, regardless of racial/ethnic group. Reducing T2D prevalence could substantially lower bladder cancer incidence among Native Hawaiians due to T2D being more common in this group. High absolute risk of bladder cancer among European Americans, regardless of T2D status, indicates that elevated bladder cancer risk in this group may be due to factors other than T2D. Future studies must explore reasons for this difference in incidence.
