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

Digna R. Velez Edwards; Katherine E. Hartmann; Melissa Wellons; Anushi Shah; Hua Xu; Todd L. Edwards

doi:10.1186/s12905-017-0386-y

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

Digna R. Velez Edwards
, Katherine E. Hartmann
, Melissa Wellons
, Anushi Shah
, Hua Xu
, Todd L. Edwards

Research output: Contribution to journal › Article › peer-review

10 Scopus citations

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.

Original language	English
Article number	28
Journal	BMC Women's Health
Volume	17
Issue number	1
DOIs	https://doi.org/10.1186/s12905-017-0386-y
State	Published - Apr 11 2017

Bibliographical note

Publisher Copyright:
© 2017 The Author(s).

Funding

This work was funded by the Building Interdisciplinary Research Careers in Women’s Health career development program (2K12HD043483-11), 1R01HD074711-02, 1R03HD078567-01, the Vanderbilt Clinical and Translational Research Scholar Award 5KL2RR024977 from the National Center for Advancing Translational Sciences, the Vanderbilt CTSA award, from the National Center for Advancing Translational Sciences, and the BioVU dataset used for the analyses described was obtained from Vanderbilt University Medical Center’s BioVU which is supported by institutional funding and by the Vanderbilt CTSA grant ULTR000445 from NCATS/NIH. The content of this manuscript are solely the responsibility of the authors and do not necessarily represent official views of the National Center for Advancing Translational Sciences or the National Institutes of Health.

Funders	Funder number
Building Interdisciplinary Research Careers in Women’s Health career development program	1R03HD078567-01, 5KL2RR024977, 1R01HD074711-02, 2K12HD043483-11
National Institutes of Health (NIH)
NIH National Institute of Child Health and Human Development National Center for Medical Rehabilitation Research	K12HD043483
National Center for Advancing Translational Sciences (NCATS)
Vanderbilt Digestive Diseases Research Center, Vanderbilt University Medical Center	ULTR000445

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 3 Good Health and Well-being

Keywords

Electronic medical records
Epidemiology
Gynecologic
Type 2 diabetes
Uterine leiomyoma

ASJC Scopus subject areas

Reproductive Medicine
Obstetrics and Gynecology

Access to Document

10.1186/s12905-017-0386-y

Cite this

@article{57dd036c2daa482baf94118c3ffb615f,

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

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.",

keywords = "Electronic medical records, Epidemiology, Gynecologic, Type 2 diabetes, Uterine leiomyoma",

author = "\{Velez Edwards\}, \{Digna R.\} and Hartmann, \{Katherine E.\} and Melissa Wellons and Anushi Shah and Hua Xu and Edwards, \{Todd L.\}",

note = "Publisher Copyright: {\textcopyright} 2017 The Author(s).",

year = "2017",

month = apr,

day = "11",

doi = "10.1186/s12905-017-0386-y",

language = "English",

volume = "17",

number = "1",

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TY - JOUR

T1 - Evaluating the role of race and medication in protection of uterine fibroids by type 2 diabetes exposure

AU - Velez Edwards, Digna R.

AU - Hartmann, Katherine E.

AU - Wellons, Melissa

AU - Shah, Anushi

AU - Xu, Hua

AU - Edwards, Todd L.

PY - 2017/4/11

Y1 - 2017/4/11

N2 - 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.

AB - 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.

KW - Electronic medical records

KW - Epidemiology

KW - Gynecologic

KW - Type 2 diabetes

KW - Uterine leiomyoma

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DO - 10.1186/s12905-017-0386-y

M3 - Article

C2 - 28399866

AN - SCOPUS:85018647414

SN - 1472-6874

VL - 17

JO - BMC Women's Health

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ER -

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

Abstract

Bibliographical note

Funding

UN SDGs

Keywords

ASJC Scopus subject areas

Access to Document

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