本研究的目标是根据社会人口特征和风险因素定义的亚组描述二型糖尿病患者中癌症死亡率的长期趋势。我们在1月1日1998年至2018年11月30日期间新被诊断为二型糖尿病的35岁及以上的个人在临床实践研究数据链接中定义了一组队列。我们按年龄、性别、种族、社会经济地位、肥胖和吸烟状态评估总死亡率、全癌症和癌症特异性死亡率的趋势。我们使用泊松回归计算年龄和日历年特定的死亡率，并使用Joinpoint回归评估每种结果的趋势。我们估计了在二型糖尿病患者中与普通人口相比的标准化死亡率比率。在137,804个个体中，在中位随访8.4年期间，从1998年至2018年，所有年龄段的总死亡率均有所下降；55岁和65岁的癌症死亡率也有所下降，但75岁和85岁的癌症死亡率增加了，平均每年百分比变化率(AAPCs)分别为-1.4%（95% CI -1.5，-1.3），-0.2%（-0.3，-0.1），1.2%（0.8，1.6）和1.6%（1.5，1.7）。女性和男性（1.5% vs 0.5% ），最不良和最贫穷者（1.5% vs 1.0%），以及极度肥胖的人与正常体重的人（5.8% vs 0.7%），女性和男性（1.5% vs 0.5%），最不良和最贫穷者（1.5% vs 1.0%），以及极度肥胖者与正常体重者（5.8% vs 0.7%）观察到更高的AAPCs，尽管所有这些分层亚组都显示癌症死亡率上升趋势。白种人和吸烟者（包括现任和前任）也观察到了癌症死亡率的上升趋势，但其他族裔群体和非吸烟者的情况则出现了下降趋势。与普通人口相比，整个研究期二型糖尿病患者患结直肠癌、胰腺癌、肝癌和子宫内膜癌的死亡率增加了1.5倍以上。与所有年龄段总死亡率下降不同的是，随年龄增长，二型糖尿病患者中癌症负担在老年人中增加，尤其是结直肠癌、胰腺癌、肝癌和子宫内膜癌。需要制定定制的癌症预防和早期检测策略来解决老年人口、最贫穷和吸烟者中持续存在的不平等问题。©2023.作者。

The aim of this study was to describe the long-term trends in cancer mortality rates in people with type 2 diabetes based on subgroups defined by sociodemographic characteristics and risk factors.We defined a cohort of individuals aged ≥35 years who had newly diagnosed type 2 diabetes in the Clinical Practice Research Datalink between 1 January 1998 and 30 November 2018. We assessed trends in all-cause, all-cancer and cancer-specific mortality rates by age, gender, ethnicity, socioeconomic status, obesity and smoking status. We used Poisson regression to calculate age- and calendar year-specific mortality rates and Joinpoint regression to assess trends for each outcome. We estimated standardised mortality ratios comparing mortality rates in people with type 2 diabetes with those in the general population.Among 137,804 individuals, during a median follow-up of 8.4 years, all-cause mortality rates decreased at all ages between 1998 and 2018; cancer mortality rates also decreased for 55- and 65-year-olds but increased for 75- and 85-year-olds, with average annual percentage changes (AAPCs) of -1.4% (95% CI -1.5, -1.3), -0.2% (-0.3, -0.1), 1.2% (0.8, 1.6) and 1.6% (1.5, 1.7), respectively. Higher AAPCs were observed in women than men (1.5% vs 0.5%), in the least deprived than the most deprived (1.5% vs 1.0%) and in people with morbid obesity than those with normal body weight (5.8% vs 0.7%), although all these stratified subgroups showed upward trends in cancer mortality rates. Increasing cancer mortality rates were also observed in people of White ethnicity and former/current smokers, but downward trends were observed in other ethnic groups and non-smokers. These results have led to persistent inequalities by gender and deprivation but widening disparities by smoking status. Constant upward trends in mortality rates were also observed for pancreatic, liver and lung cancer at all ages, colorectal cancer at most ages, breast cancer at younger ages, and prostate and endometrial cancer at older ages. Compared with the general population, people with type 2 diabetes had a more than 1.5-fold increased risk of colorectal, pancreatic, liver and endometrial cancer mortality during the whole study period.In contrast to the declines in all-cause mortality rates at all ages, the cancer burden has increased in older people with type 2 diabetes, especially for colorectal, pancreatic, liver and endometrial cancer. Tailored cancer prevention and early detection strategies are needed to address persistent inequalities in the older population, the most deprived and smokers.© 2023. The Author(s).