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...
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| Format: | Article |
| Language: | English |
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Japan Epidemiological Association
2025-01-01
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| Series: | Journal of Epidemiology |
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| Online Access: | https://www.jstage.jst.go.jp/article/jea/35/1/35_JE20230310/_pdf |
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| author | 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 |
| author_facet | 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 |
| author_sort | Yong-Moon Mark Park |
| collection | DOAJ |
| description | 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. |
| format | Article |
| id | doaj-art-786a3ac9f3e3426db03dd72c76dd9b50 |
| institution | Kabale University |
| issn | 0917-5040 1349-9092 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | Japan Epidemiological Association |
| record_format | Article |
| series | Journal of Epidemiology |
| spelling | doaj-art-786a3ac9f3e3426db03dd72c76dd9b502025-01-06T03:54:45ZengJapan Epidemiological AssociationJournal of Epidemiology0917-50401349-90922025-01-01351303810.2188/jea.JE20230310Income Dynamics and Risk of Colorectal Cancer in Individuals With Type 2 Diabetes: A Nationwide Population-based Cohort StudyYong-Moon Mark Park0Benjamin C. Amick III1Pearl A. McElfish2Clare C. Brown3Mario Schootman4Marie-Rachelle Narcisse5Seong-Su Lee6Yoon Jin Choi7Kyungdo Han8Department of Epidemiology, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR, USADepartment of Epidemiology, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR, USADepartment of Internal Medicine, College of Medicine, University of Arkansas for Medical Sciences Northwest, Springdale, AR, USADepartment of Health Policy and Management, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR, USAWinthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USADepartment of Internal Medicine, College of Medicine, University of Arkansas for Medical Sciences Northwest, Springdale, AR, USADivision of Endocrinology and Metabolism, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, South KoreaDepartment of Gastroenterology, National Cancer Center, Goyang, South KoreaDepartment of Statistics and Actuarial Science, Soongsil University, Seoul, South KoreaBackground: 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.https://www.jstage.jst.go.jp/article/jea/35/1/35_JE20230310/_pdftype 2 diabetesincome dynamicscolorectal cancerrisk factor |
| spellingShingle | 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 Income Dynamics and Risk of Colorectal Cancer in Individuals With Type 2 Diabetes: A Nationwide Population-based Cohort Study Journal of Epidemiology type 2 diabetes income dynamics colorectal cancer risk factor |
| title | Income Dynamics and Risk of Colorectal Cancer in Individuals With Type 2 Diabetes: A Nationwide Population-based Cohort Study |
| title_full | Income Dynamics and Risk of Colorectal Cancer in Individuals With Type 2 Diabetes: A Nationwide Population-based Cohort Study |
| title_fullStr | Income Dynamics and Risk of Colorectal Cancer in Individuals With Type 2 Diabetes: A Nationwide Population-based Cohort Study |
| title_full_unstemmed | Income Dynamics and Risk of Colorectal Cancer in Individuals With Type 2 Diabetes: A Nationwide Population-based Cohort Study |
| title_short | Income Dynamics and Risk of Colorectal Cancer in Individuals With Type 2 Diabetes: A Nationwide Population-based Cohort Study |
| title_sort | income dynamics and risk of colorectal cancer in individuals with type 2 diabetes a nationwide population based cohort study |
| topic | type 2 diabetes income dynamics colorectal cancer risk factor |
| url | https://www.jstage.jst.go.jp/article/jea/35/1/35_JE20230310/_pdf |
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