Role of Insulin Use and Social Determinants of Health on Non-melanoma Skin Cancer: Results From the Behavioral Risk Factor Surveillance System

Abstract

Background Non-melanoma skin cancer (NMSC) is a frequent type of malignancy with a steadily increasing incidence rate worldwide. Although NMSC was shown to be associated with diabetes, no studies have addressed the extent to which insulin use influences the risk of NMSC in light of social determinants of health (SDOH). We conducted a quantitative study that examined the interplay between insulin use, SDOH, additional covariates, and NMSC among individuals with diabetes. Methods We based our analysis on the 2020 Behavioral Risk Factor Surveillance System (BRFSS), a national survey conducted yearly in the US. We performed weighted chi-squared test, logistic regression, and survival analyses on 8685 eligible participants with diabetes enrolled in the BRFSS. Results Kaplan Meier survival curves showed higher probability of NMSC event-free survival for participants with diabetes using insulin compared to participants with diabetes not using insulin (log-rank test P < .001). Significant associations were detected between insulin use and reduced odds of NMSC (OR .56; 95% CI: .38-.82), and decreased hazard (HR .36; 95% CI: .21-.62), along with indices of SDOH. Conclusions Our findings suggest that socioeconomic differences related to the healthcare system and behavioral patterns are linked to discrepancies in the use of insulin and the development of NMSC.

The Analysis Study of Association of Type 2 Diabetes Mellitus and Skin Cancer : A Comprehensive Systematic Review

“…Elevated blood glucose levels are a hallmark of diabetes, a chronic medical condition. 1 It has become a burden on the socioeconomic structure and poses a threat to public health. 2 Research has found that individuals with diabetes mellitus (DM) face a higher risk of developing certain cancers, such as those affecting the liver, biliary tract, pancreas, stomach, colorectum, kidney, bladder, breast, and endometrium, but a lower risk of developing prostate cancer.…”

“…9 Other trials, such as the ORIGIN trial, have not found any increased risk of any particular cancer types, such as lung, breast, prostate, colorectal, or melanoma, associated with insulin therapy, despite the DIGAMI trial's indication of a correlation between the medication and higher cancer mortality. 1 Melanoma and nonmelanoma skin cancer, which includes squamous cell carcinoma, basal cell carcinoma, and malignant neoplasm of the sweat and sebaceous glands, are the two main types of skin cancer. These were some of Taiwan's top ten most prevalent cancer types.…”

“…NMSC is one of the most prevalent cancers in North America, particularly in older White men. 1 Since its prevalence and incidence rate have been steadily rising over the past three decades, NMSC has become recognized as a significant public health issue of international concern. The primary risk factors for non-malignant solar cell carcinoma (NMSC) are fair skin, a history of sun damage, and prolonged exposure to ultraviolet (UV), particularly ultraviolet B (UVB) radiation.…”

“…The primary risk factors for non-malignant solar cell carcinoma (NMSC) are fair skin, a history of sun damage, and prolonged exposure to ultraviolet (UV), particularly ultraviolet B (UVB) radiation. 1 In addition, the Disability-Adjusted Life Years (DALYs) for NMSC increase exponentially with age, according to the Global Burden of Disease Study (1990Study ( -2017. In general, it is discovered that men experience NMSC at a higher rate than women.…”

“…As a final point, despite the fact that smoking has been consistently associated with a number of cancer types, there is evidence that current smoking is associated with a lower risk of NSMC. 1 However, there hasn't been much research done on DM patients' risk of developing skin cancer. Epidemiological studies conducted in other nations have shown varying correlations between malignant melanoma or NMSC and type 2 diabetes, with relatively few reports describing the relationship between NMSC and DM.…”