{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,1]],"date-time":"2026-08-01T00:45:46Z","timestamp":1785545146751,"version":"3.56.0"},"reference-count":57,"publisher":"JMIR Publications Inc.","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JMIR Public Health Surveill"],"abstract":"Abstract<\/jats:title>\n \n Background<\/jats:title>\n Colorectal cancer (CRC) and diabetes share many common lifestyle risk factors, such as obesity. However, it remains largely unknown how different factors interact to influence the risk of CRC development among patients with diabetes.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n This study aimed to identify the interaction patterns among factors associated with the risk of CRC incidence among patients with diabetes.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n This is a retrospective cohort study conducted using electronic health records from Hong Kong. Patients who were diagnosed with type 2 diabetes and received care in general outpatient clinics between 2010 and 2019 without cancer history were included and followed up until December 2019. A conditional inference survival tree was applied to examine the interaction patterns among factors associated with the risk of CRC.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n A total of 386,325 patients were included. During a median follow-up of 6.2 years (IQR 3.3-8.0), 4199 patients developed CRC. Patients were first partitioned into 4 age groups by increased levels of CRC risk (\u226454 vs 55 to 61 vs 62 to 73 vs >73 years). Among patients aged more than 54 years, male sex was the dominant risk factor for CRC within each age stratum and the associations lessened with age. Abdominal obesity (waist-to-hip ratio >0.95) and longer duration of diabetes (median 12, IQR 7-18 vs median 4, IQR 1-11 years) were identified as key risk factor for CRC among men aged between 62 and 73 years and women aged more than 73 years, respectively.<\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n This study suggests the interaction patterns among age, sex, waist-to-hip ratio, and duration of diabetes on the risk of CRC incidence among patients with diabetes. Findings of the study may help identify target groups for public health intervention strategies.<\/jats:p>\n <\/jats:sec>","DOI":"10.2196\/62756","type":"journal-article","created":{"date-parts":[[2025,4,29]],"date-time":"2025-04-29T16:48:09Z","timestamp":1745945289000},"page":"e62756-e62756","source":"Crossref","is-referenced-by-count":6,"title":["Survival Tree Analysis of Interactions Among Factors Associated With Colorectal Cancer Risk in Patients With Type 2 Diabetes: Retrospective Cohort Study"],"prefix":"10.2196","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-7650-6583","authenticated-orcid":false,"given":"Sarah Tsz Yui","family":"Yau","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2103-8377","authenticated-orcid":false,"given":"Chi Tim","family":"Hung","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8267-1785","authenticated-orcid":false,"given":"Eman Yee Man","family":"Leung","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5888-5660","authenticated-orcid":false,"given":"Albert","family":"Lee","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1721-9450","authenticated-orcid":false,"given":"Eng Kiong","family":"Yeoh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1010","published-online":{"date-parts":[[2025,4,29]]},"reference":[{"issue":"3","key":"R1","doi-asserted-by":"publisher","first-page":"229","DOI":"10.3322\/caac.21834","article-title":"Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries","volume":"74","author":"Bray","journal-title":"CA Cancer J Clin"},{"issue":"22","key":"R2","doi-asserted-by":"publisher","first-page":"1679","DOI":"10.1093\/jnci\/dji375","article-title":"Diabetes mellitus and risk of colorectal cancer: a meta-analysis","volume":"97","author":"Larsson","journal-title":"J Natl Cancer Inst"},{"issue":"8","key":"R3","doi-asserted-by":"publisher","first-page":"794","DOI":"10.1056\/NEJMsr1606602","article-title":"Body fatness and cancer--viewpoint of the IARC working group","volume":"375","author":"Lauby-Secretan","journal-title":"N Engl J Med"},{"key":"R4","doi-asserted-by":"publisher","DOI":"10.1136\/bmj-2021-067516","article-title":"Anthropometric and adiposity indicators and risk of type 2 diabetes: systematic review and dose-response meta-analysis of cohort studies","volume":"376","author":"Jayedi","journal-title":"BMJ"},{"issue":"23","key":"R5","doi-asserted-by":"publisher","first-page":"2765","DOI":"10.1001\/jama.2008.839","article-title":"Smoking and colorectal cancer: a meta-analysis","volume":"300","author":"Botteri","journal-title":"JAMA"},{"issue":"12","key":"R6","doi-asserted-by":"publisher","first-page":"958","DOI":"10.1016\/S2213-8587(15)00316-2","article-title":"Relation of active, passive, and quitting smoking with incident type 2 diabetes: a systematic review and meta-analysis","volume":"3","author":"Pan","journal-title":"Lancet Diabetes Endocrinol"},{"issue":"3","key":"R7","doi-asserted-by":"publisher","first-page":"861","DOI":"10.1002\/ijc.32377","article-title":"Meta-analysis of 16 studies of the association of alcohol with colorectal cancer","volume":"146","author":"McNabb","journal-title":"Int J Cancer"},{"issue":"9","key":"R8","doi-asserted-by":"publisher","first-page":"1804","DOI":"10.2337\/dc15-0710","article-title":"Alcohol consumption and the risk of type 2 diabetes: a systematic review and dose-response meta-analysis of more than 1.9 million individuals from 38 observational studies","volume":"38","author":"Knott","journal-title":"Diabetes Care"},{"issue":"5","key":"R9","doi-asserted-by":"publisher","first-page":"882","DOI":"10.1038\/sj.bjc.6606045","article-title":"Physical activity and risk of colon adenoma: a meta-analysis","volume":"104","author":"Wolin","journal-title":"Br J Cancer"},{"issue":"7","key":"R10","doi-asserted-by":"publisher","first-page":"529","DOI":"10.1007\/s10654-015-0056-z","article-title":"Physical activity and the risk of type 2 diabetes: a systematic review and dose-response meta-analysis","volume":"30","author":"Aune","journal-title":"Eur J Epidemiol"},{"issue":"3","key":"R11","doi-asserted-by":"publisher","first-page":"366","DOI":"10.1038\/s41430-018-0234-7","article-title":"Dietary patterns derived from principal component analysis (PCA) and risk of colorectal cancer: a systematic review and meta-analysis","volume":"73","author":"Garcia-Larsen","journal-title":"Eur J Clin Nutr"},{"issue":"20","key":"R12","doi-asserted-by":"publisher","first-page":"2235","DOI":"10.1001\/archinte.164.20.2235","article-title":"Dietary patterns, meat intake, and the risk of type 2 diabetes in women","volume":"164","author":"Fung","journal-title":"Arch Intern Med"},{"issue":"3","key":"R13","doi-asserted-by":"publisher","first-page":"201","DOI":"10.7326\/0003-4819-136-3-200202050-00008","article-title":"Dietary patterns and risk for type 2 diabetes mellitus in U.S. men","volume":"136","author":"van Dam","journal-title":"Ann Intern Med"},{"issue":"9","key":"R14","doi-asserted-by":"publisher","first-page":"937","DOI":"10.1007\/s10654-021-00741-9","article-title":"Consumption of red meat and processed meat and cancer incidence: a systematic review and meta-analysis of prospective studies","volume":"36","author":"Farvid","journal-title":"Eur J Epidemiol"},{"issue":"11","key":"R15","doi-asserted-by":"publisher","first-page":"1436","DOI":"10.1038\/s41416-018-0314-4","article-title":"Type 2 diabetes and risk of colorectal cancer in two large U.S. prospective cohorts","volume":"119","author":"Ma","journal-title":"Br J Cancer"},{"issue":"6","key":"R16","doi-asserted-by":"publisher","first-page":"676","DOI":"10.1016\/j.cgh.2009.01.008","article-title":"Gender as a risk factor for advanced neoplasia and colorectal cancer: a systematic review and meta-analysis","volume":"7","author":"Nguyen","journal-title":"Clin Gastroenterol Hepatol"},{"issue":"1","key":"R17","doi-asserted-by":"publisher","first-page":"124","DOI":"10.3748\/wjg.v24.i1.124","article-title":"Systematic review of colorectal cancer screening guidelines for average-risk adults: summarizing the current global recommendations","volume":"24","author":"B\u00e9nard","journal-title":"World J Gastroenterol"},{"issue":"19","key":"R18","doi-asserted-by":"publisher","first-page":"1965","DOI":"10.1001\/jama.2021.6238","article-title":"Screening for colorectal cancer: US Preventive Services Task Force recommendation statement","volume":"325","author":"US Preventive Services Task Force","journal-title":"JAMA"},{"issue":"11","key":"R19","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1003431","article-title":"Risk of colorectal cancer in patients with diabetes mellitus: a Swedish nationwide cohort study","volume":"17","author":"Ali Khan","journal-title":"PLoS Med"},{"issue":"10","key":"R20","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2023.39670","article-title":"Personalized initial screening age for colorectal cancer in individuals at average risk","volume":"6","author":"Chen","journal-title":"JAMA Netw Open"},{"issue":"7","key":"R21","doi-asserted-by":"publisher","first-page":"1674","DOI":"10.2337\/dc10-0666","article-title":"Diabetes and cancer: a consensus report","volume":"33","author":"Giovannucci","journal-title":"Diabetes Care"},{"issue":"6","key":"R22","doi-asserted-by":"publisher","DOI":"10.1042\/BSR20170945","article-title":"Abdominal obesity and colorectal cancer risk: systematic review and meta-analysis of prospective studies","volume":"37","author":"Dong","journal-title":"Biosci Rep"},{"key":"R23","doi-asserted-by":"publisher","DOI":"10.1038\/s41366-024-01680-7","article-title":"Central obesity may account for most of the colorectal cancer risk linked to obesity: evidence from the UK Biobank prospective cohort","author":"Safizadeh","journal-title":"Int J Obes (Lond)"},{"issue":"1","key":"R24","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2024.54753","article-title":"Colorectal cancer and central obesity","volume":"8","author":"Safizadeh","journal-title":"JAMA Netw Open"},{"key":"R25","doi-asserted-by":"publisher","DOI":"10.1016\/j.ebiom.2023.104821","article-title":"Gut microbiota in the pathogenesis and therapeutic approaches of diabetes","volume":"97","author":"Crudele","journal-title":"EBioMedicine"},{"issue":"11","key":"R26","doi-asserted-by":"publisher","first-page":"690","DOI":"10.1038\/s41575-019-0209-8","article-title":"Gut microbiota in colorectal cancer: mechanisms of action and clinical applications","volume":"16","author":"Wong","journal-title":"Nat Rev Gastroenterol Hepatol"},{"issue":"7978","key":"R27","doi-asserted-by":"publisher","first-page":"389","DOI":"10.1038\/s41586-023-06466-x","article-title":"Gut microbial carbohydrate metabolism contributes to insulin resistance","volume":"621","author":"Takeuchi","journal-title":"Nature New Biol"},{"issue":"4","key":"R28","doi-asserted-by":"publisher","first-page":"1138","DOI":"10.1053\/j.gastro.2010.06.072","article-title":"Prospective study reveals associations between colorectal cancer and type 2 diabetes mellitus or insulin use in men","volume":"139","author":"Campbell","journal-title":"Gastroenterology"},{"issue":"6","key":"R29","doi-asserted-by":"publisher","first-page":"587","DOI":"10.1016\/s1542-3565(05)00152-7","article-title":"Type 2 diabetes mellitus and the risk of colorectal cancer","volume":"3","author":"Yang","journal-title":"Clin Gastroenterol Hepatol"},{"issue":"6","key":"R30","doi-asserted-by":"publisher","first-page":"542","DOI":"10.1093\/jnci\/91.6.542","article-title":"Prospective study of adult onset diabetes mellitus (type 2) and risk of colorectal cancer in women","volume":"91","author":"Hu","journal-title":"JNCI Journal of the National Cancer Institute"},{"issue":"5","key":"R31","doi-asserted-by":"publisher","first-page":"361","DOI":"10.1016\/S2213-8587(18)30051-2","article-title":"Novel subgroups of adult-onset diabetes and their association with outcomes: a data-driven cluster analysis of six variables","volume":"6","author":"Ahlqvist","journal-title":"Lancet Diabetes Endocrinol"},{"issue":"9","key":"R32","doi-asserted-by":"publisher","first-page":"684","DOI":"10.1016\/S2213-8587(19)30187-1","article-title":"Risk of diabetes-associated diseases in subgroups of patients with recent-onset diabetes: a 5-year follow-up study","volume":"7","author":"Zaharia","journal-title":"Lancet Diabetes Endocrinol"},{"issue":"1","key":"R33","doi-asserted-by":"publisher","DOI":"10.1038\/s43856-023-00360-3","article-title":"Precision subclassification of type 2 diabetes: a systematic review","volume":"3","author":"Misra","journal-title":"Commun Med (Lond)"},{"issue":"24","key":"R34","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph17249523","article-title":"The identification of diabetes mellitus subtypes applying cluster analysis techniques: a systematic review","volume":"17","author":"Sarr\u00eda-Santamera","journal-title":"Int J Environ Res Public Health"},{"issue":"4","key":"R35","doi-asserted-by":"publisher","first-page":"329","DOI":"10.14341\/DM12405","article-title":"Classification of diabetes. World Health Organization 2019. What\u2019s new?","volume":"23","author":"Kononenko","journal-title":"Diabetes mellitus"},{"issue":"1","key":"R36","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1038\/s41435-022-00192-6","article-title":"Gene-environment interactions and their impact on human health","volume":"24","author":"Virolainen","journal-title":"Genes Immun"},{"issue":"9","key":"R37","doi-asserted-by":"publisher","first-page":"2315","DOI":"10.1002\/ijc.32057","article-title":"Gene-environment interactions and colorectal cancer risk: an umbrella review of systematic reviews and meta-analyses of observational studies","volume":"145","author":"Yang","journal-title":"Int J Cancer"},{"issue":"3","key":"R38","doi-asserted-by":"publisher","first-page":"511","DOI":"10.1038\/s41416-023-02312-z","article-title":"Probing the diabetes and colorectal cancer relationship using gene - environment interaction analyses","volume":"129","author":"Dimou","journal-title":"Br J Cancer"},{"issue":"8","key":"R39","doi-asserted-by":"publisher","first-page":"1376","DOI":"10.1136\/gutjnl-2024-331914","article-title":"Heavy arch: from inflammatory bowel diseases to metabolic disorders","volume":"73","author":"Adolph","journal-title":"Gut"},{"issue":"3","key":"R40","doi-asserted-by":"publisher","first-page":"651","DOI":"10.1198\/106186006X133933","article-title":"Unbiased recursive partitioning: a conditional inference framework","volume":"15","author":"Hothorn","journal-title":"J Comput Graph Stat"},{"issue":"2","key":"R41","doi-asserted-by":"publisher","first-page":"81","DOI":"10.4093\/dmj.2017.41.2.81","article-title":"A clinical practice guideline to guide a system approach to diabetes care in Hong Kong","volume":"41","author":"Lau","journal-title":"Diabetes Metab J"},{"issue":"6","key":"R42","doi-asserted-by":"publisher","first-page":"1607","DOI":"10.1007\/s00125-012-2525-1","article-title":"Diabetes and cancer (1): evaluating the temporal relationship between type 2 diabetes and cancer incidence","volume":"55","author":"Johnson","journal-title":"Diabetologia"},{"issue":"11","key":"R43","doi-asserted-by":"publisher","first-page":"1350","DOI":"10.1038\/nm.3967","article-title":"The consensus molecular subtypes of colorectal cancer","volume":"21","author":"Guinney","journal-title":"Nat Med"},{"issue":"9","key":"R44","doi-asserted-by":"publisher","first-page":"505","DOI":"10.1016\/j.trecan.2016.07.008","article-title":"Colorectal cancer subtypes: developmental origin and microenvironmental regulation","volume":"2","author":"Fessler","journal-title":"Trends Cancer"},{"issue":"1","key":"R45","doi-asserted-by":"publisher","DOI":"10.1186\/s12967-017-1346-x","article-title":"Application of survival tree analysis for exploration of potential interactions between predictors of incident chronic kidney disease: a 15-year follow-up study","volume":"15","author":"Ramezankhani","journal-title":"J Transl Med"},{"issue":"1","key":"R46","doi-asserted-by":"publisher","first-page":"115","DOI":"10.1016\/j.cgh.2018.07.011","article-title":"Prevalence of and risk factors for colorectal neoplasia in asymptomatic young adults (20-39 years old)","volume":"17","author":"Kim","journal-title":"Clin Gastroenterol Hepatol"},{"issue":"10","key":"R47","doi-asserted-by":"publisher","first-page":"2981","DOI":"10.3748\/wjg.v22.i10.2981","article-title":"Characteristics of and risk factors for colorectal neoplasms in young adults in a screening population","volume":"22","author":"Lee","journal-title":"World J Gastroenterol"},{"issue":"1","key":"R48","doi-asserted-by":"publisher","DOI":"10.1038\/s41467-020-14396-9","article-title":"Sexual-dimorphism in human immune system aging","volume":"11","author":"M\u00e1rquez","journal-title":"Nat Commun"},{"issue":"7","key":"R49","doi-asserted-by":"publisher","first-page":"e284","DOI":"10.1097\/MCG.0000000000001086","article-title":"Abdominal obesity is more predictive of advanced colorectal neoplasia risk than overall obesity in men: a cross-sectional study","volume":"53","author":"Kim","journal-title":"J Clin Gastroenterol"},{"issue":"2","key":"R50","doi-asserted-by":"publisher","DOI":"10.1016\/j.esmoop.2023.101204","article-title":"Sex and gender perspectives in colorectal cancer","volume":"8","author":"Baraibar","journal-title":"ESMO Open"},{"issue":"1","key":"R51","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1007\/s10552-016-0831-5","article-title":"Sex differences in the association of obesity and colorectal cancer risk","volume":"28","author":"Kim","journal-title":"Cancer Causes Control"},{"issue":"1","key":"R52","doi-asserted-by":"publisher","first-page":"19","DOI":"10.1111\/j.1467-789X.2009.00613.x","article-title":"A quantitative analysis of body mass index and colorectal cancer: findings from 56 observational studies","volume":"11","author":"Ning","journal-title":"Obes Rev"},{"issue":"1","key":"R53","doi-asserted-by":"publisher","first-page":"359","DOI":"10.1152\/physrev.00033.2011","article-title":"Pathophysiology of human visceral obesity: an update","volume":"93","author":"Tchernof","journal-title":"Physiol Rev"},{"issue":"6","key":"R54","doi-asserted-by":"publisher","first-page":"1315","DOI":"10.2337\/db11-1300","article-title":"The critical role of metabolic pathways in aging","volume":"61","author":"Barzilai","journal-title":"Diabetes"},{"issue":"6","key":"R55","doi-asserted-by":"publisher","first-page":"813","DOI":"10.1634\/theoncologist.2011-0462","article-title":"Cancer risk associated with use of metformin and sulfonylurea in type 2 diabetes: a meta-analysis","volume":"17","author":"Soranna","journal-title":"Oncologist"},{"key":"R56","doi-asserted-by":"publisher","DOI":"10.3389\/fendo.2022.874344","article-title":"Sulfonylurea and cancer risk among patients with type 2 diabetes: a population-based cohort study","volume":"13","author":"Zhao","journal-title":"Front Endocrinol (Lausanne)"},{"key":"R57","doi-asserted-by":"publisher","DOI":"10.1016\/j.canep.2019.101658","article-title":"Anti-diabetic medications and the risk for colorectal cancer: a population-based nested case-control study","volume":"64","author":"Shin","journal-title":"Cancer Epidemiol"}],"container-title":["JMIR Public Health and Surveillance"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/publichealth.jmir.org\/2025\/1\/e62756","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T22:31:29Z","timestamp":1785537089000},"score":1,"resource":{"primary":{"URL":"https:\/\/publichealth.jmir.org\/2025\/1\/e62756"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,4,29]]},"references-count":57,"URL":"https:\/\/doi.org\/10.2196\/62756","relation":{},"ISSN":["2369-2960"],"issn-type":[{"value":"2369-2960","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,4,29]]},"article-number":"v11i3e62756"}}