Impact of race, sex and age on the probability of pancreatic cancer among patients with newly diagnosed diabetes

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ABSTRACT Background Pancreatic cancer diagnoses are frequently preceded by a new diabetes diagnosis. Screening individuals newly diagnosed with diabetes could enable earlier pancreatic cancer detection. We sought to estimate the risk of pancreatic cancer by age, sex, race and time since diabetes diagnosis. Methods Johns Hopkins Medicine conducted this de-identified claims-based cohort study using the Optum Labs Data Warehouse (OLDW). Enrollees from 1/2008–9/2018 were identified as non-diabetic or newly diagnosed diabetics and time to pancreatic cancer analysis was conducted using a flexible Weibull model. Diabetes and cancer were defined using ICD-9/10 codes. Results Our risk set included 4,732,313 individuals (424,129 newly diabetic) in 5,844,934 enrollment periods. Individuals with newly diagnosed diabetes were at an increased hazard ratio (HR) of pancreatic cancer but this effect waned over time. The HR of pancreatic cancer following a diabetes diagnosis was higher in younger individuals and varied by race (lower HR in non-White individuals) (p<0.01, main effects and interactions). Thus, the probability of pancreatic cancer following a diabetes diagnosis was dependent on age, race, and sex. For example: the 1-year probability of pancreatic cancer in a white male aged 75 was 0.45% (95%CI 0.41%-0.49%) if they were newly diagnosed with diabetes and 0.090% (95%CI 0.084%-0.096%) fi they were free of diabetes. In contrast, risk was lower if they were age 55 at 0.15% (new-diabetic, 95%CI 0.13%-0.16) and 0.022% (diabetes free, 95%CI 0.020%-0.023%). The HR of pancreatic cancer for individuals with newly diagnosed diabetes compared to those free of diabetes was highest 1 month after diagnosis (HR=9.6 and 14.7 for a 75 and 55 year old while male, respectively) but decreased in the following months, with a ∼39% reduction in HR from 1- to-3 months, ∼17% from 3 -to-6 months, and ∼14% from 6 month-to -1 year (p<0.01). Conclusions Consideration of the age-race-sex specific probability of pancreatic cancer and time since diabetes diagnosis is necessary to when evaluating the risk of pancreatic cancer following a diabetes diagnosis.

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