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01.12.2017 | Research article | Ausgabe 1/2017 Open Access

BMC Women's Health 1/2017

Evaluating the role of race and medication in protection of uterine fibroids by type 2 diabetes exposure

Zeitschrift:
BMC Women's Health > Ausgabe 1/2017
Autoren:
Digna R. Velez Edwards, Katherine E. Hartmann, Melissa Wellons, Anushi Shah, Hua Xu, Todd L. Edwards
Wichtige Hinweise

Electronic supplementary material

The online version of this article (doi:10.​1186/​s12905-017-0386-y) contains supplementary material, which is available to authorized users.

Abstract

Background

Uterine fibroids (UF) affect 77% of women by menopause, and account for $9.4 billion in annual healthcare costs. Type-2-diabetes (T2D) has inconsistently associated with protection from UFs in prior studies. To further evaluate the relationship between T2D and UFs we tested for association between T2D and UF risk in a large clinical population as well as the potential differences due to T2D medications and interaction with race.

Methods

This nested case–control study is derived from a clinical cohort. Our outcome was UF case-control status and our exposure was T2D. UF outcomes and T2D exposure were classified using validated electronic medical record (EMR) algorithms. Logistic regression, adjusted for covariates, was used to model the association between T2D diagnosis and UF risk. Secondary analyses were performed evaluating the interaction between T2D exposure and race and stratifying T2D exposed subjects by T2D medication being taken.

Results

We identified 3,789 subjects with UF outcomes (608 UF cases and 3,181 controls), 714 were diabetic and 3,075 were non-diabetic. We observed a nominally significant interaction between T2D exposure and race in adjusted models (interaction p = 0.083). Race stratified analyses demonstrated more protection by T2D exposure on UF risk among European Americans (adjusted odds ratio [aOR] = 0.50, 95% CI 0.35 to 0.72) than African Americans (aOR = 0.76, 95% CI 0.50 to 1.17). We also observed a protective effect by T2D regardless of type of T2D medication being taken, with slightly more protection among subjects on insulin treatments (European Americans aOR = 0.42, 95% CI 0.26 to 0.68; African Americans aOR = 0.60, 95% CI 0.36 to 1.01).

Conclusions

These data, conducted in a large population of UF cases and controls, support prior studies that have found a protective association between diabetes presence and UF risk and is further modified by race. Protection from UFs by T2D exposure was observed regardless of medication type with slightly more protection among insulin users. Further mechanistic research in larger cohorts is necessary to reconcile the potential role of T2D in UF risk.
Zusatzmaterial
Additional file 1: Table S1. Study population characteristics and demographic variables by T2D exposure. Provides a summary of study participant characteristics stratified by our primary exposure, type 2 diabetes. (DOCX 17 kb)
12905_2017_386_MOESM1_ESM.docx
Literatur
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