Suicide and Cardiovascular Death after a Cancer Diagnosis
Suicide and Cardiovascular Death after a Cancer Diagnosis
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DOI：
10.1056/nejmoa1110307
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发表时间：
2012-04-05
影响因子：
158.5
通讯作者：
Valdimarsdottir, Unnur
中科院分区：
文献类型：
--
作者：
Fang, Fang;Fall, Katja;Valdimarsdottir, Unnur
接受癌症诊断是一种创伤性经历，可能会引发疾病或治疗影响之外的直接不良健康后果。方法使用泊松和负二项回归模型，我们进行了一项涉及6,073,240名瑞典人的历史队列研究，以检查1991年至2006年癌症诊断与自杀或心血管原因死亡的直接风险之间的关系。为了校正未测量的混杂因素，我们还对队列中所有死于自杀或心血管疾病的癌症患者进行了巢式、自匹配的病例交叉分析。结果与非癌症患者相比，接受癌症诊断的患者在第一周（29例患者，发病率为2.50 / 1000人-年）的相对自杀风险为12.6(95%置信区间[CI]， 8.6 - 17.8)，在第一年（260例患者，发病率为0.60 / 1000人-年）的相对自杀风险为3.1 （95% CI, 2.7 - 3.5）。诊断后心血管死亡的相对风险在第一周为5.6 (95% CI, 5.2 - 5.9)（1318例患者，发病率为116.80 / 1000人-年），在前4周为3.3 (95% CI, 3.1 - 3.4)（2641例患者，发病率为65.81 / 1000人-年）。在诊断后的第一年，风险升高迅速下降。对于预后不良的癌症，风险增加尤为明显。病例交叉分析在很大程度上证实了主分析的结果。结论：在这项大型队列研究中，与无癌症患者相比，最近接受癌症诊断的患者自杀和死于心血管疾病的风险都增加了。（由瑞典工作生活和社会研究委员会和其他机构资助。）
BACKGROUNDReceiving a diagnosis of cancer is a traumatic experience that may trigger immediate adverse health consequences beyond the effects of the disease or treatment.METHODSUsing Poisson and negative binomial regression models, we conducted a historical cohort study involving 6,073,240 Swedes to examine the associations between a cancer diagnosis and the immediate risk of suicide or death from cardiovascular causes from 1991 through 2006. To adjust for unmeasured confounders, we also performed a nested, self-matched case-crossover analysis among all patients with cancer who died from suicide or cardiovascular diseases in the cohort.RESULTSAs compared with cancer-free persons, the relative risk of suicide among patients receiving a cancer diagnosis was 12.6 (95% confidence interval [CI], 8.6 to 17.8) during the first week (29 patients; incidence rate, 2.50 per 1000 person-years) and 3.1 (95% CI, 2.7 to 3.5) during the first year (260 patients; incidence rate, 0.60 per 1000 personyears). The relative risk of cardiovascular death after diagnosis was 5.6 (95% CI, 5.2 to 5.9) during the first week (1318 patients; incidence rate, 116.80 per 1000 person-years) and 3.3 (95% CI, 3.1 to 3.4) during the first 4 weeks (2641 patients; incidence rate, 65.81 per 1000 person-years). The risk elevations decreased rapidly during the first year after diagnosis. Increased risk was particularly prominent for cancers with a poor prognosis. The case-crossover analysis largely confirmed results from the main analysis.CONCLUSIONSIn this large cohort study, patients who had recently received a cancer diagnosis had increased risks of both suicide and death from cardiovascular causes, as compared with cancer-free persons. (Funded by the Swedish Council for Working Life and Social Research and others.)