Published online Apr 16, 2021. doi: 10.12998/wjcc.v9.i11.2433
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
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.
To investigate the effect of T2DM and race on the adenoma detection rate (ADR) in screening colonoscopies in two disparate populations.
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).
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.
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.