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©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
Impact of type 2 diabetes on adenoma detection in screening colonoscopies performed in disparate populations
Dimitri F Joseph, Ellen Li, Samuel L Stanley III, Yi-Cong Zhu, Xiao-Ning Li, Jie Yang, Lorenzo F Ottaviano, Juan Carlos Bucobo, Jonathan M Buscaglia, Joshua D Miller, Rajesh Veluvolu, Michele Follen, Evan B Grossman
Dimitri F Joseph, Lorenzo F Ottaviano, Juan Carlos Bucobo, Jonathan M Buscaglia, Joshua D Miller, Department of Medicine, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY 11794-8173, United States
Ellen Li, Department of Medicine, Division of Gastroenterology, Stony Brook University, Stony Brook, NY 11794-8173, United States
Samuel L Stanley III, Yi-Cong Zhu, Jie Yang, Department of Applied Mathematics and Statistics, Stony Brook University, Stony Brook, NY 11794-3600, United States
Xiao-Ning Li, Department of Biostatistics and Bioinformatics Shared Resource, Stony Brook Cancer Center, Stony Brook University, Stony Brook, NY 11794-3600, United States
Jie Yang, Department of Family, Population, and Preventative Medicine, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY 11794-8461, United States
Rajesh Veluvolu, Evan B Grossman, Department of Medicine, NYC Health and Hospitals/Kings County, Brooklyn, NY 11203, United States
Rajesh Veluvolu, Evan B Grossman, Department of Medicine, SUNY Downstate Medical Center, Brooklyn, NY 11203, United States
Michele Follen, Department of Obstetrics and Gynecology, NYC Health and Hospitals/Kings County, Brooklyn, NY 11203, United States
Author contributions: Grossman EB, Follen M, Miller JD and Li E performed the study concept and design; Joseph DF, Li E, Grossman EB, Ottaviano LF and Bucobo JC collected data; Joseph DF, Stanley III SL, Zhu YC, Li XN and Yang J performed the statistical analysis; Joseph DF and Li E drafted the manuscript; Li XN, Yang J, Ottaviano LF, Bucobo JC, Buscaglia JM, Miller JD, Veluvolu R and Follen M performed critical reviews of important intellectual content; all authors approved the final version of the manuscript.
Supported by Stony Brook University Targeted Research Opportunity Seed Fusion Grant, No. 1135373-3-37298; National Cancer Institute, No. P20 CA192994; Simons Foundation, No. 415604.
Institutional review board statement: The study was reviewed and approved by the Stony Brook University Institutional Review Board, No. 180023; SUNY Downstate Medical Center Institutional Review Board, No. 802718.
Informed consent statement: A waiver of consent was obtained by both the SUNY DMC and Stony Brook University IRBs for retrospective collection and analysis of deidentified demographic and medical data.
Conflict-of-interest statement: The authors declare no competing interests.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at ellen.li@stonybrookmedicine.edu. A waiver of consent was obtained by both the SUNY DMC and Stony Brook University IRBs for retrospective collection and analysis of deidentified demographic and medical data. Because the presented data are deidentified, the risk of identification is low.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
http://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Ellen Li, MD, PhD, Emeritus Professor, Department of Medicine, Division of Gastroenterology, Stony Brook University, HSC T17-060, Stony Brook, NY 11794-8173, United States. ellen.li@stonybrookmedicine.edu
Received: December 5, 2020
Peer-review started: December 5, 2020
First decision: December 17, 2020
Revised: December 23, 2020
Accepted: February 25, 2021
Article in press: February 25, 2021
Published online: April 16, 2021
BACKGROUND
The Black/African Ancestry (AA) population has a higher prevalence of type 2 diabetes mellitus (T2DM) and a higher incidence and mortality rate for colorectal cancer (CRC) than all other races in the United States. T2DM has been shown to increase adenoma risk in predominantly white/European ancestry (EA) populations, but the effect of T2DM on adenoma risk in Black/AA individuals is less clear. We hypothesize that T2DM has a significant effect on adenoma risk in a predominantly Black/AA population.
AIM
To investigate the effect of T2DM and race on the adenoma detection rate (ADR) in screening colonoscopies in two disparate populations.
METHODS
A retrospective cohort study was conducted on ADR during index screening colonoscopies (age 45-75) performed at an urban public hospital serving a predominantly Black/AA population (92%) (2017-2018, n = 1606). Clinical metadata collected included basic demographics, insurance, body mass index (BMI), family history of CRC, smoking, diabetes diagnosis, and aspirin use. This dataset was combined with a recently reported parallel retrospective cohort data set collected at a suburban university hospital serving a predominantly White/EA population (87%) (2012-2015, n = 2882).
RESULTS
The ADR was higher in T2DM patients than in patients without T2DM or prediabetes (35.2% vs 27.9%, P = 0.0166, n = 981) at the urban public hospital. Multivariable analysis of the combined datasets showed that T2DM [odds ratio (OR) = 1.29, 95% confidence interval (CI): 1.08-1.55, P = 0.0049], smoking (current vs never OR = 1.47, 95%CI: 1.18-1.82, current vs past OR = 1.32, 95%CI: 1.02-1.70, P = 0.0026), older age (OR = 1.05 per year, 95%CI: 1.04-1.06, P < 0.0001), higher BMI (OR = 1.02 per unit, 95%CI: 1.01-1.03, P = 0.0003), and male sex (OR = 1.87, 95%CI: 1.62-2.15, P < 0.0001) were associated with increased ADR in the combined datasets, but race, aspirin use and insurance were not.
CONCLUSION
T2DM, but not race, is significantly associated with increased ADR on index screening colonoscopy while controlling for other factors.
Core Tip: This retrospective cohort study examines the factors associated with the adenoma detection rate (ADR) during initial screening colonoscopy in two disparate populations. One population comprised predominantly underinsured Black/African Ancestry individuals served by an urban public hospital, and the second population predominantly insured White/European Ancestry individuals served by a suburban university hospital. The results show that type 2 diabetes was significantly associated with increased ADR in both populations. In addition, while older age, higher body mass index, smoking and male sex were also associated with increased ADR, race, aspirin use and insurance were not significant in the multivariable analysis of the combined datasets.
