Pancreatic cancer risk was higher in the insulin users compared with the non-insulin users in the crude model (RR = 2.55, 95% CI 1.04–6.26, P = 0.042), but was not statistically significant after fully adjusted (RR = 2.73, 95% CI 0.93–7.99, P = 0.067). This evidence concerns the gene INS and pancreatic neoplasm.