Association Between Low-Dose Aspirin Use and Colorectal Cancer Incidence in Taiwan
Journal
JAMA network open
Journal Volume
3
Journal Issue
11
Date Issued
2020
Author(s)
Abstract
Importance: Population-based East Asian data have corroborated reports from non-Asian settings on the association between low-dose aspirin and a lower risk of colorectal cancer (CRC). Objective: To evaluate the association between duration and recency of low-dose aspirin use and CRC risk. Design, Setting, and Participants: This nested case-control study included individuals whso initiated aspirin use and matched individuals who did not use aspirin. Data were collected from Taiwan National Health Insurance and Taiwan Cancer Registry from 2000 through 2015. CRC cases were age-and sex-matched in a 1:4 ratio with individuals in a control group, identified from a cohort of individuals who used and did not use aspirin through risk-set sampling. Data analysis was conducted from June 2018 to July 2019. Exposures: Low-dose aspirin use was defined as receiving less than 150 mg per day, whereas 100 mg/d was most commonly used. Based on duration and recency of low-dose aspirin use between cohort entry (initiation date of low-dose aspirin for aspirin use group or randomly assigned date for those who did not use aspirin) and index date (CRC diagnosis date for individuals in the case group and the diagnosis date for the 4 corresponding matched individuals in the control group), the 3 following mutually exclusive exposure groups served as the basis for analysis: (1) long-term current low-dose aspirin use, (2) episodic low-dose aspirin use, and (3) no low-dose aspirin use (the reference group). Main Outcomes and Measures: CRC risk among the 3 exposure groups. Results: Among 4710504 individuals (2747830 [51.7%] men; median [interquartile range] age at cohort entry in initiator group, 61 [52-71] years; median [interquartile range] age at cohort entry in nonuse group, 59 [51-68] years), 79095 CRC cases (1.7% of study cohort) were identified. Compared with no low-dose aspirin use, the adjusted odds ratio (OR) for long-term current low-dose aspirin use and CRC risk was 0.89 (95% CI, 0.85-0.93); for episodic use, 0.88 (95% CI, 0.86-0.89). Adjusted ORs of 0.69 (95% CI, 0.63-0.76) and 0.64 (95% CI, 0.61-0.67) were observed for long-term current use and episodic low-dose aspirin use within the subcohort of individuals who initiated low-dose aspirin between age 40 and 59 years. Conclusions and Relevance: In this study, low-dose aspirin use was associated with 11% lower CRC risk in an East Asian population, and this association was larger when low-dose aspirin use started before age 60 years. ? 2020 American Medical Association. All rights reserved.
SDGs
Other Subjects
2,4 thiazolidinedione derivative; acetylsalicylic acid; angiotensin receptor antagonist; beta adrenergic receptor blocking agent; calcium channel blocking agent; cholinergic receptor blocking agent; cyclooxygenase 2 inhibitor; dipeptidyl carboxypeptidase inhibitor; dipeptidyl peptidase IV inhibitor; diuretic agent; glucagon like peptide 1; histamine H2 receptor antagonist; hydroxymethylglutaryl coenzyme A reductase inhibitor; insulin; metformin; nonsteroid antiinflammatory agent; proton pump inhibitor; sulfonylurea; acetylsalicylic acid; antithrombocytic agent; adult; aged; angina pectoris; Article; brain ischemia; cancer risk; cancer staging; case control study; cohort analysis; colonoscopy; colorectal cancer; comorbidity; controlled study; Crohn disease; disease association; drug indication; drug megadose; drug use; familial adenomatous polyposis; female; gastrointestinal hemorrhage; health care utilization; heart failure; human; hypertension; liver failure; low drug dose; major clinical study; male; peptic ulcer; peripheral vascular disease; population based case control study; priority journal; sex ratio; Taiwan; treatment duration; ulcerative colitis; age; colorectal tumor; middle aged; odds ratio; pathology; protection; Adult; Age Factors; Aged; Aspirin; Case-Control Studies; Colorectal Neoplasms; Female; Humans; Male; Middle Aged; Neoplasm Staging; Odds Ratio; Platelet Aggregation Inhibitors; Protective Factors; Taiwan
Publisher
NLM (Medline)
Type
journal article