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Type 2 diabetes, smoking, insulin use, and mortality from hepatocellular carcinoma: a 12-year follow-up of a national cohort in Taiwan

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Abstract

Background

The effect of smoking and insulin use in the association between diabetes and hepatocellular carcinoma (HCC) is not known.

Materials and methods

Age-standardized HCC mortality trends during 1995–2006 in the general population were calculated. A total of 88,694 type 2 diabetic patients aged ≥25 years recruited in 1995–1998 were followed till 2006. Age- and sex-specific mortality rates and the mortality rate ratios (vs. the average mortality rates in the general population) were calculated. Risk factors were evaluated by Cox regression.

Results

The age-standardized mortality trend slightly increased significantly in women but was steady in men. For diabetic patients aged ≥25 years, 830 men and 515 women died of HCC during 1995–2006. Mortality rate ratios (95 % confidence interval) were larger with the decreasing age: 7.36 (6.52, 8.31), 2.48 (2.22, 2.78), 1.79 (1.59, 2.02), and 1.87 (1.51, 2.32) for age 25–54, 55–64, 65–74, and ≥75 years for men, respectively, 10.12 (7.73, 13.25), 4.08 (3.57, 4.67), 2.45 (2.15, 2.78), and 1.71 (1.34, 2.19) for women. Age, male sex, lower BMI, smoking, and insulin use were associated with HCC mortality, but diabetes duration was not. Smoking and insulin use carried a significantly higher risk of 22–29 % and 37–58 %, respectively, without interaction. A dose-responsive pattern between the duration of insulin use and HCC mortality was noted, with a relative risk of 1.5–1.7 in those who used insulin for ≥10 years.

Conclusions

Diabetic patients have a higher risk of HCC mortality, which is more remarkable in the younger age. Smoking and insulin are potentially modifiable risk factors.

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Acknowledgements

The author thanks the following institutes in Taiwan for their continuous support on epidemiologic studies of diabetes and arsenic-related health hazards: the Department of Health (DOH89-TD-1035, DOH97-TD-D-113-97009) and the National Science Council (NSC-86-2314-B-002-326, NSC-87-2314-B-002-245, NSC-88-2621-B-002-030, NSC89-2320-B002-125, NSC-90-2320-B-002-197, NSC-92-2320-B-002-156, NSC-93-2320-B-002-071, NSC-94-2314-B-002-142, NSC-95-2314-B-002-311, NSC-96-2314-B-002-061-MY2, and NSC 101-2314-B-002-117).

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Authors and Affiliations

  1. Division of Endocrinology and Metabolism, Department of Internal Medicine, National Taiwan University College of Medicine, Taipei, Taiwan

    Chin-Hsiao Tseng

  2. Department of Internal Medicine, National Taiwan University Hospital, No. 7 Chung-Shan South Road, Taipei, Taiwan

    Chin-Hsiao Tseng

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  1. Chin-Hsiao Tseng
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Correspondence to Chin-Hsiao Tseng.

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Tseng, CH. Type 2 diabetes, smoking, insulin use, and mortality from hepatocellular carcinoma: a 12-year follow-up of a national cohort in Taiwan. Hepatol Int 7, 693–702 (2013). https://doi.org/10.1007/s12072-012-9405-0

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