Long-term conditions, multimorbidity and colorectal cancer risk in the UK Biobank cohort

PURPOSE: Early identification of colorectal cancer (CRC) is an international priority. Multimorbidity (presence of ≥2 long-term conditions (LTCs)) is increasing and the relationship between CRC and LTCs is little-understood. This study explores the relationship between individual LTCs, multimorbidity and CRC incidence and mortality. METHODS: Longitudinal analysis of the UK Biobank cohort, participants recruited 2006–2010; N = 500,195; excluding previous CRC at baseline. Baseline data was linked with cancer/mortality registers. Demographic characteristics, lifestyle factors, 43 LTCs, CRC family history, non-CRC cancers, and multimorbidity count were recorded. Variable selection models identified candidate LTCs potentially predictive of CRC outcomes and Cox regression models tested for significance of associations between selected LTCs and outcomes. RESULTS: Participants’ age range: 37–73 (mean age 56.5; 54.5% female). CRC was diagnosed in 3669 (0.73%) participants, and 916 (0.18%) died from CRC during follow-up (median follow-up 7 years). CRC incidence was higher in the presence of heart failure (Hazard Ratio (HR) 1.96, 95% Confidence Interval (CI) 1.13–3.40), diabetes (HR 1.15, CI 1.01–1.32), glaucoma (HR 1.36, CI 1.06–1.74), male cancers (HR 1.44, CI 1.01–2.08). CRC mortality was higher in presence of epilepsy (HR 1.83, CI 1.03–3.26), diabetes (HR 1.32, CI 1.02–1.72), osteoporosis (HR 1.67, CI 1.12–2.58). No significant association was found between multimorbidity (≥2 LTCs) and CRC outcomes. CONCLUSIONS: The associations of certain LTCs with CRC incidence and mortality has implications for clinical practice: presence of certain LTCs in patients presenting with CRC symptoms could trigger early investigation and diagnosis. Future research should explore causative mechanisms and patient perspectives.