Mortality outcomes in lung cancer patients with and without type 2 diabetes: a cohort study in England
Author(s)
Type
Journal Article
Abstract
Introduction
The impact of type 2 diabetes (T2DM) on mortality following lung cancer diagnosis remains unclear, with conflicting evidence across studies We aimed to to assess differences in all-cause and cause-specific mortality between lung cancer patients with and without T2DM within a primary care population in England.
Methods
The study population were 69,674 people with incident lung cancer within the Clinical Practice Research Datalink (CPRD) Aurum primary care database (2010-2022). The study exposure was T2DM at cancer diagnosis and the outcomes were all-cause and cause-specific mortality (cancer, cardio-vascular, respiratory). Cox models were fitted for each outcome adjusting for age, gender, smoking status, body mass index, calendar year and socioeconomic status (Index of Multiple Deprivation).
Results
After adjusting for age and gender there was no evidence for a difference in all-cause mortality in people with T2DM compared with people without T2DM (IRR 0.98 95%CI 0.96, 1.01). After additional adjustment for all confounders there was a small positive effect (IRR 1.07 95% CI 1.04, 1.09). After adjusting for age and gender people with T2DM had lower rates of cancer-specific mortality compared to people without T2DM (IRR 0.96 95% CI 0.94, 0.98). However, after adjustment for all measured confounders there was a small positive association (IRR 1.05 95% CI 1.02, 1.07). In both age and gender adjusted and fully adjusted models people with T2DM had higher cardiovascular (fully adjusted HR 1.30 95%CI 1.15, 1.47) and respiratory disease mortality (fully adjusted HR 1.30 95% CI 1.15, 1.47).
Conclusions
There was robust evidence that people with T2DM had higher cardiovascular and respiratory disease mortality following lung cancer diagnosis. The relationships between T2DM and all-cause and cancer-specific mortality were highly sensitive to adjustment for confounding. Differences in studies on approaches to confounding and levels of missing data may contribute to the mixed findings on this association in the literature.
The impact of type 2 diabetes (T2DM) on mortality following lung cancer diagnosis remains unclear, with conflicting evidence across studies We aimed to to assess differences in all-cause and cause-specific mortality between lung cancer patients with and without T2DM within a primary care population in England.
Methods
The study population were 69,674 people with incident lung cancer within the Clinical Practice Research Datalink (CPRD) Aurum primary care database (2010-2022). The study exposure was T2DM at cancer diagnosis and the outcomes were all-cause and cause-specific mortality (cancer, cardio-vascular, respiratory). Cox models were fitted for each outcome adjusting for age, gender, smoking status, body mass index, calendar year and socioeconomic status (Index of Multiple Deprivation).
Results
After adjusting for age and gender there was no evidence for a difference in all-cause mortality in people with T2DM compared with people without T2DM (IRR 0.98 95%CI 0.96, 1.01). After additional adjustment for all confounders there was a small positive effect (IRR 1.07 95% CI 1.04, 1.09). After adjusting for age and gender people with T2DM had lower rates of cancer-specific mortality compared to people without T2DM (IRR 0.96 95% CI 0.94, 0.98). However, after adjustment for all measured confounders there was a small positive association (IRR 1.05 95% CI 1.02, 1.07). In both age and gender adjusted and fully adjusted models people with T2DM had higher cardiovascular (fully adjusted HR 1.30 95%CI 1.15, 1.47) and respiratory disease mortality (fully adjusted HR 1.30 95% CI 1.15, 1.47).
Conclusions
There was robust evidence that people with T2DM had higher cardiovascular and respiratory disease mortality following lung cancer diagnosis. The relationships between T2DM and all-cause and cancer-specific mortality were highly sensitive to adjustment for confounding. Differences in studies on approaches to confounding and levels of missing data may contribute to the mixed findings on this association in the literature.
Date Issued
2025-12-01
Date Acceptance
2025-06-27
Citation
Clinical Epidemiology, 2025, 17
ISSN
1179-1349
Publisher
Dove Medical Press
Journal / Book Title
Clinical Epidemiology
Volume
17
Copyright Statement
© 2025 Igbinosa et al. This work is published by Dove Medical Press Limited, and licensed under a Creative Commons Attribution License. The full terms of the License are available at https://creativecommons.org/licenses/by/4.0/. The license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
License URL
Publication Status
Published
Date Publish Online
2025-07-16