Abstract 30: Impact of race, sex and age on the risk of pancreatic cancer in new onset diabetics in real-world data
Authors: Porter Nancy R. , Afghani Elham , Lau Bryan , Goggins Michael , Klein Alison P. 
Published: July 2021

Background: Pancreatic cancer (PC) is the 3rd leading cause of cancer death in the US with a 5 year survival rate of 10%. Diabetes (DM) is both a risk factor and early symptom of PC. Individuals with longstanding DM have a 2-fold increased risk of PC, and up to 1% of older new-onset diabetics (NOD) develop PC within 3 years of their NOD diagnosis. We examined if individuals with NOD could be identified in real world data and estimate the risk of PC for subgroups defined by age, sex and race.

Methods: Johns Hopkins School of Medicine conducted this study using the OptumLabs® Data Warehouse (OLDW). The OLDW contains de-identified retrospective administrative claims data, including medical and pharmacy claims and eligibility information. Enrollees from 1/2008-9/2018 with 2 ICD-9 or ICD-10 DM codes after a 1 year wash-out period were considered NOD. Enrollees with no claims evidence of DM for at least a 1-year prior to a randomly selected index date were non-DM. Those with prevalent DM were excluded. Time-to-event analysis was conducted using a flexible Weibull survival model.

Results: Our cohort included 5,845,240 individuals, &gt;25% of which are non-White. There were 424,210 (7.3%) cases of NOD of which 1,594 (0.38%) were diagnosed with PC within 2 years of their NOD diagnosis: In the non-NOD cohort 4,865 (0.09%) developed PC. The risk of PC among NOD patients varied by age, sex and race (p&lt;0.05). The interaction between NOD and age was significant (p&lt;0.05). At age 50, white men with NOD had higher relative hazard (RH) of PC at 6 months (6.4) as compared to other races (Black: 4.8; Asians: 4.9, Hispanics: 4.7). By age 70 the NOD RH in men was lower (white: 4.6; Black: 3.5; Hispanics: 3.4; Asian: 3.6). In all groups the NOD RH decreased over time from NOD diagnosis. Risk of PC increased dramatically with age, such that despite the lower RH for PC in DM at older ages, there is a markedly higher predicted incidence of PC in older individuals. For example, among women, after 24 months, the predicted incidence of PC by group were: NOD Whites: 40.7 per 10,000 persons; NOD Blacks: 38.4; Non-NOD Whites 10.5; non-NOD Blacks 13.2 at age 70 compared to NOD Whites: 13.5; NOD Blacks: 12.7; Non-NOD Whites 2.6; non-NOD Blacks 3.2 at age 50.

Conclusions: Precise estimates of PC risk associated with NOD as observed in real-world data is necessary optimize targeting screening for this risk group. We show using claims data that individuals with NOD can be identified and the overall risk in this population is consistent with prior observational studies. The large representative size of the OLDW allows us to estimate risk by age, race and sex, a necessary step for planning the successful interception of PC in this cohort.

Citation Format: Nancy R. Porter, Elham Afghani, Bryan Lau, Michael Goggins, Alison P. Klein. Impact of race, sex and age on the risk of pancreatic cancer in new onset diabetics in real-world data [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2021; 2021 Apr 10-15 and May 17-21. Philadelphia (PA): AACR; Cancer Res 2021;81(13_Suppl):Abstract nr 30.