Table 1.
Baseline characteristic of studies included in the systematic review and meta-analysis
| Study | Country | Study design | Sample size | Mean age or age range | Men/women | DM types | Percentage of smoker (%) | Reported outcomes | Effect estimate | Follow-up duration (years) | Maximum adjustment |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Verona Diabetes Study 2003 [38] | Italy | Prospective | 7148 | 66.6 | 3366/3782 | II | 20.9 | EC death, GC death, CRC death, HCC death, PC death | SMR | 10.0 | Age, treatment, smoking, BMI |
| Veneto Region 2014 [26] | Italy | Prospective | 167,621 | 30.0–89.0 | 91,521/76,100 | II | NA | EC death, GC death, CRC death, HCC death, PC death | SMR | 3.0 | Age, specific regional |
| Uppsala Health Care Region 1991 [22] | Sweden | Prospective | 51,008 | > 20.0 | 27,862/23,146 | Both | NA | EC, GC, CC, RC, HCC, PC | RR | 19.0 | Age, follow-up duration |
| Takayama Study cohort 2013 [39] | Japan | Prospective | 28,565 | 55.2 | 14,173/16,547 | Both | 32.7 | EC, GC, CC, RC, HCC, PC | HR | 13.2 | Age at baseline, smoking, BMI, PA, education, history of hypertension, stroke, IHD, TEI, and intake of fat, ethanol, and coffee |
| The Singapore Chinese Health Study 2006/2013 [40, 41] |
Singapore | Prospective | 61,320 | 56.4 | 27,328/33,992 | Both | 30.6 | CRC, HCC | HR | 10.0 | Age, year of recruitment, gender, dialect group, education, smoking, alcohol, BMI, and consumption of coffee and tea |
| SMHS and SWHS 2013/2015 [42, 43] | China | Prospective | 133,288 | 53.8 | 61,491/74,942 | II | 33.0 | GC, HCC | HR | 5.5/11.2 | Age, birth cohort, education, income, BMI, occupation, smoking, alcohol, family history of cancer, TEI, fruit intake, vegetable intake, total PA, history of CH or CLD, HRT, and menopausal status |
| Ragozzino 1982 [44] | US | Prospective | 1135 | NA | NA | Both | NA | GC, CRC, PC | RR | 8.6 | Age |
| Limburg 2006 [45] | US | Retrospective | 1975 | 61.0 | 997/978 | II | 57.0 | CRC | SIR | 16.9 | Age and calendar period |
| PHARMO Database 2017 [46] | Netherlands | Prospective | 68,076 | 63.9 | 34,686/33,390 | II | NA | EC, GC, CC, RC, HCC, PC | HR | 13.0 | Age, use of statins, PPI, anti-hypertensives 90 days prior to start of each time-interval |
| Gini 2016 [47] | Italy | Retrospective | 32,247 | 65.0 | 17,827/14,420 | II | NA | CRC, HCC, PC | SIR | 3.7 | Age and year at cancer diagnosis |
| NIH-AARP Diet and Health Study 2011 [48] |
US | Prospective | 469,448 | 62.0 | 280,883/188,565 | Both | 14.0 | EC, GC | HR | 8.0 | Age, calories, alcohol, smoking, fruit consumption, vegetable consumption, ethnicity, education, and PA |
| Korean Cancer Prevention Study 2005 [49] | Korea | Prospective | 1,298,385 | 46.9 | 829,770/468,615 | II | 38.9 | GC death, CRC death, HCC death, PC death | HR | 10.0 | Age, age squared, smoking, and alcohol |
| NHANESI 1995 [50] | US | Prospective | 14,407 | 49.1 | NA | Both | 30.2 | CRC | OR | 17.0 | Age, BMI, smoking, alcohol, income, and recreational PA |
| The Cardiovascular Health Study 1999 [51] | US | Prospective | 5849 | 72.8 | 2478/3371 | Both | 12.0 | CRC | RR | 6.4 | Age and PA |
| Fujino 2001 [52] | Japan | Prospective | 4902 | 55.2 | 2444/2458 | Both | 30.3 | HCC | RR | 10.3 | Age, smoking, alcohol, history of hepatitis, and cirrhosis |
| Clalit Health Care Services 2013 [53] | Israel | Retrospective | 87,934 | 51.5 | 43,632/44,302 | II | 5.8 | CRC, PC | SIR | 10.0 | Age |
| Clalit Health Services 2016 [54] | Israel | Prospective | 2,186,196 | 46.6 | 1,034,074/1,152,122 | II | 31.6 | GC, CRC, HCC, PC | HR | 10.1 | Age, socioeconomic status, and ethnic group |
| Danish Central Hospital Discharge Register 1997 [25] | Denmark | Prospective | 109,581 | 66.5 | 54,571/55,010 | Both | NA | EC, GC, CC, RC, HCC, PC | SIR | 5.7 | Age, follow-up duration |
| Cancer Prevention Study 1998 [55] | US | Prospective | 863,699 | 52.3 | 352,849/510,850 | Both | 40.6 | CRC | RR | 13.0 | Age, race, educational level, BMI, smoking, alcohol, dietary intake, aspirin use, PA, and family history of CRC |
| D2C cohort 2011 [56] | Germany | Prospective | 26,742 | 64.0 | 12,650/14,092 | II | 17.2 | CRC, HCC, PC | SIR | 3.7 | BMI, diabetes duration, and medication at study entry |
| Diabetes Registry Tyrol 2014 [57] | Austria | Prospective | 7627 | 59.0 | 4126/3501 | Both | NA | GC, CRC, HCC, PC | SIR | 6.0 | Age |
| Koskinen 1998 [58] | Finland | Prospective | 114,058 | 30.0–74.0 | NA | Both | NA | GC, CC | SMR | 5.0 | Age |
| EPIC-Norfolk Study 2004 [59] | UK | Prospective | 9605 | 59.0 | 4445/5160 | Both | 11.7 | CRC | RR | 6.0 | Age, BMI, and smoking |
| Xu 2015 [60] | China | Retrospective | 36,379 | 59.0 | 16,166/20,213 | II | NA | GC, CC, RC, HCC, PC | SIR | 3.7 | Age |
| Newfoundland and Labrador 2013 [61] | Canada | Retrospective | 122,228 | > 30.0 | 61,156/61,072 | Both | NA | CRC, CC, RC | HR | 10.5 | Age, and severity of co-morbid illness |
| Netherlands Cohort Study 2016 [62] | Netherlands | Prospective | 120,852 | 55.0–69.0 | 58,279/62,573 | II | NA | CRC, CC, RC | HR | 17.3 | Age, BMI, pants/skirt size, family history of CRC, smoking, alcohol, dietary habits and nonoccupational PA |
| Maccabi Healthcare Services 2010 [63] | Israel | Retrospective | 100,595 | 61.6 | 52,913/47,682 | Both | 9.6 | EC, GC, CC, RC, HCC, PC | HR | 8.0 | Age, region, SES level, use of healthcare services a year prior to index date, BMI, and history of CVD |
| National Health Screening Service 2001 [21] | Norway | Prospective | 75,219 | 49.2 | 36,975/38,244 | Both | NA | CRC, CC | RR | 12.0 | Age |
| Nationwide Cohort Study in Sweden 1995 [64] | Sweden | Retrospective | 134,096 | NA | 63,987/70,109 | Both | NA | PC | SIR | 6.7 | Age entered cohort, year entered cohort, initial hospitalization, hospital discharges, diabetic complications, follow-up |
| The Multiethnic Cohort 2010 [65] | US | Prospective | 199,142 | 59.9 | 89,478/109,664 | Both | NA | CRC | RR | 13.0 | Race, age at baseline questionnaire, BMI, smoking, NSAIDs use, education, alcohol, saturated fat intake, unsaturated fat intake, dietary fibre intake, PA, family history of CRC. |
| Wang 2015 [23] | China | Prospective | 327,268 | 59.4 | 163,819/163,449 | II | NA | EC, GC, CC, RC, HCC, PC | SIR | 7.0 | Age and urbanization level of area registered in the system |
| Zhang 2012 [66, 67] | China | Retrospective | 7938 | 61.1 | 3792/4146 | II | NA | EC, GC, CRC, CC, RC, HCC, PC | SIR | 2.6 | Age, surveillance region and the observed person-years in type 2 diabetes |
| Japan Public Health Center- Based Prospective Study 2006 [68, 69] | Japan | Prospective | 97,771 | 51.6 | 46,548/51,223 | Both | 40.8 | GC, CC, RC, HCC, PC | HR | 10.7 | Age at baseline, study area, history of cerebrovascular disease, history of IHD, smoking, ethanol intake, BMI, leisure-time PA, green vegetable intake, and coffee intake |
| Cancer Prevention Study II 2004 [19, 20] | US | Prospective | 1,056,243 | 56.7 | 467,922/588,321 | Both | 20.3 | EC death, GC death, CC death, RC death, HCC death, PC death | RR | 14.8 | Age, race, years of education, BMI, smoking, alcohol, total red meat consumption, consumption of citrus fruits and juices, consumption of vegetables, PA |
| Japan Collaborative Cohort Study 2006 [70, 71] | Japan | Prospective | 56,881 | 57.1 | 23,378/33,503 | Both | 23.5 | GC, CRC death, CC, RC, HCC, PC | RR | 8.0 | Age, BMI, family history of cancer, smoking, drinking habit, sports, walking, and education |
| National Health Insurance Program 2014 [24] | China | Retrospective | 9,884,228 | > 20.0 | 5,419,238/4,464,990 | II | NA | EC, GC, CRC, HCC, PC | SIR | 10.0 | Insurance premium, urbanization degree of area registered for National Health Insurance program, and age |
| Zhou 2010 [72] | 7 countries in Europe | Prospective | 44,655 | 53.3 | 26,460/18,195 | Both | 34.1 | HCC death, PC death | HR | 5.9–36.8 | Study cohort, age, BMI, SBP, cholesterol and smoking |
| EPOCH-JAPAN 2017 [73] | Japan | Prospective | 46,387 | 57.7 | 20,426/25,961 | Both | 27.5 | PC death | HR | 14.6 | Age, BMI, smoking, and alcohol |
BMI: body mass index; CC: colon cancer; CH: chronic hepatitis; CLD: chronic liver disease; CRC: colorectal cancer; CVD: cardiovascular disease; DM: diabetes mellitus; EC: esophagus cancer; GC: gastric cancer; HCC: hepatocellular carcinoma; HR: hazard ratio; HRT: hormone replacement therapy; IHD: ischemic heart disease; OR: odds ratios; PA: physical activity; PC: pancreatic cancer; PPI: proton pump inhibitors; RC: rectal cancer; RR: relative risk; SBP: systolic blood pressure; SIR: standardized incidence ratio; SMHS: Shanghai Men’s Health Study; SMR: standardized mortality ratio; SWHS: Shanghai Women’s Health Study; TEI: total energy intake; UK: United Kingdom; US: Unite States