Austin M Wheeler1,2, Punyasha Roul2, Yangyuna Yang2, Kaitlyn M Brittan1,2, Harlan Sayles2,3, Namrata Singh4, Brian C Sauer5, Grant W Cannon5, Joshua F Baker6, Ted R Mikuls1,2, Bryant R England1,2. 1. VA Nebraska-Western Iowa Health Care System, Omaha, NE. 2. Division of Rheumatology & Immunology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE. 3. Department of Biostatistics, College of Public Health, University of Nebraska Medical Center, Omaha, NE. 4. University of Washington, Seattle, WA. 5. Salt Lake City VA Healthcare System & University of Utah, Salt Lake City, UT. 6. Corporal Michael J. Crescenz VA Medical Center & University of Pennsylvania, Philadelphia, PA.
Abstract
OBJECTIVE: Patients with rheumatoid arthritis (RA) have an increased risk of select cancers, including lymphoma and lung cancer. Whether RA influences prostate cancer risk is uncertain. We aimed to determine the risk of prostate cancer in patients with RA compared to patients without RA in the Veterans Health Administration (VA). METHODS: We performed a matched (up to 1:5) cohort study of males with and without RA in the VA from 2000 to 2018. RA status, as well as covariates, were obtained from national VA databases. Prostate cancer was identified through linked VA cancer databases and the National Death Index. Multivariable Cox models compared prostate cancer risk between RA and non-RA, including models that accounted for retention in the VA system. RESULTS: We included 56,514 veterans with RA and 227,284 veterans without RA. During 2,337,104 patient-years of follow-up, 6,550 prostate cancers occurred. Prostate cancer incidence (per 1,000 patient-years) was 3.50 (95% CI 3.32, 3.69) in RA and 2.66 (95% CI 2.58, 2.73) in non-RA. After accounting for confounders and censoring for attrition of VA healthcare, RA was modestly associated with a higher prostate cancer risk (adjusted HR 1.12 [95% CI 1.04, 1.20]). There was no association between RA and prostate cancer mortality (adjusted HR 0.92 [95% CI 0.73, 1.16]). CONCLUSION: RA was associated with a modestly increased risk of prostate cancer, but not prostate cancer mortality, after accounting for relevant confounders and several potential sources of bias. However, even minimal unmeasured confounding could explain these findings. This article is protected by copyright. All rights reserved.
OBJECTIVE: Patients with rheumatoid arthritis (RA) have an increased risk of select cancers, including lymphoma and lung cancer. Whether RA influences prostate cancer risk is uncertain. We aimed to determine the risk of prostate cancer in patients with RA compared to patients without RA in the Veterans Health Administration (VA). METHODS: We performed a matched (up to 1:5) cohort study of males with and without RA in the VA from 2000 to 2018. RA status, as well as covariates, were obtained from national VA databases. Prostate cancer was identified through linked VA cancer databases and the National Death Index. Multivariable Cox models compared prostate cancer risk between RA and non-RA, including models that accounted for retention in the VA system. RESULTS: We included 56,514 veterans with RA and 227,284 veterans without RA. During 2,337,104 patient-years of follow-up, 6,550 prostate cancers occurred. Prostate cancer incidence (per 1,000 patient-years) was 3.50 (95% CI 3.32, 3.69) in RA and 2.66 (95% CI 2.58, 2.73) in non-RA. After accounting for confounders and censoring for attrition of VA healthcare, RA was modestly associated with a higher prostate cancer risk (adjusted HR 1.12 [95% CI 1.04, 1.20]). There was no association between RA and prostate cancer mortality (adjusted HR 0.92 [95% CI 0.73, 1.16]). CONCLUSION: RA was associated with a modestly increased risk of prostate cancer, but not prostate cancer mortality, after accounting for relevant confounders and several potential sources of bias. However, even minimal unmeasured confounding could explain these findings. This article is protected by copyright. All rights reserved.
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