Metabolic syndrome and risk of esophageal adenocarcinoma in elderly patients in the United States: An analysis of SEER‐Medicare data

Abstract

Background Metabolic syndrome (MetS) is associated with cancer risk and increases the risk of Barrett’s esophagus, the precursor lesion of esophageal adenocarcinoma (EA), primarily in the absence of gastroesophageal reflux disease (GERD). However, little is known about whether MetS is associated with risk of EA. Methods Using the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked database we evaluated whether MetS was associated with EA. EA cases (n=3,167) were compared with individually matched population controls (5:1); a subset of EA cases (n=575) were able to be individually matched to Barrett’s esophagus controls (n=575). MetS was defined using ICD-9-CM codes in the period 1–3 years prior to EA diagnosis or control selection. Unconditional logistic regression was used to estimate adjusted odds ratios (ORs) and 95% confidence intervals (95% CIs). Potential effect-modification by GERD symptoms and sex was examined in stratified models. Results EA was significantly associated with MetS (OR: 1.16, 95%CI: 1.06, 1.26) compared with population controls. In males, the association was restricted to those without prior GERD, however in females MetS was associated with EA regardless of GERD status. Effect modification by sex was observed (p-interaction=0.01). MetS was not associated with EA risk when compared with Barrett’s esophagus controls. Conclusions In this older population, MetS was associated with an increased risk of EA in males without GERD and females regardless of GERD status. Given the lack of an association when compared with Barrett’s esophagus controls, MetS may impact EA risk by primarily increasing risk of the precursor lesion Barrett’s esophagus.

Diabetes in relation to Barrett’s esophagus and adenocarcinomas of the esophagus: A pooled study from the International Barrett’s and Esophageal Adenocarcinoma Consortium

“…22 The other studies included were either esophageal squamous cell carcinoma, the other primary type of esophageal cancer which has a different etiology, 67 or a mixture of histological subtypes. Several previous studies have suggested that diabetes increases the risk of EA, [23][24][25][26][27][28] whereas others showed…”

“…The other studies included were either esophageal squamous cell carcinoma, the other primary type of esophageal cancer which has a different etiology, or a mixture of histological subtypes. Several previous studies have suggested that diabetes increases the risk of EA, whereas others showed no association . Of the 3 prior studies showing no association between diabetes and EA, 1 is included in the current pooled analysis .…”

“…In the current study, we report a synergistic interaction between diabetes and symptomatic regurgitation, but not overall reflux symptoms (defined as heartburn or regurgitation symptoms). Three prior studies that assessed this interaction reported that reflux did not modify the diabetes‐EA/EGJA association . However, 2 of these studies defined GERD as coded in medical records and were not able to stratify by heartburn or regurgitation symptoms …”

“…19,20 Diabetes has been increasing in prevalence, and 12% of adults in the United States 18,19 and 9% worldwide 21 have prevalent diabetes. However, the association between diabetes and EA/EGJA remains understudied, 22 with several studies suggesting an increased risk [23][24][25][26][27][28] and others showing no association. [29][30][31] In addition, few studies have assessed the association between diabetes and BE, with inconsistent results.…”

“…Three prior studies that assessed this interaction reported that reflux did not modify the diabetes-EA/EGJA association. 23,28,31 However, 2 of these studies defined GERD as coded in medical records and were not able to stratify by heartburn or regurgitation symptoms. 28,31 Few studies have assessed the association between diabetes and BE, and the results have been inconsistent.…”