Impact of severe mental illness on cancer stage at diagnosis and subsequent mortality: A population-based register study
Impact of severe mental illness on cancer stage at diagnosis and subsequent mortality: A population-based register study
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DOI：
10.1016/j.schres.2018.05.011
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发表时间：
2018-11-01
影响因子：
4.5
通讯作者：
Laursen, T. M.
中科院分区：
文献类型：
--
作者：
Toender, A.;Munk-Olsen, T.;Laursen, T. M.
背景：严重精神疾病 (SMI) 患者的死亡率过高通常是由于身体合并症和医疗保健欠佳造成的。癌症是常见的死亡原因，诊断时的肿瘤分期是死亡率的有力预测指标。我们的目的是研究患有 SMI 的个体与没有 SMI 的个体相比的癌症发病率、诊断时的疾病阶段以及随后的死亡率。方法：使用全国登记处对 1978 年至 2013 年整个丹麦人口进行跟踪。对患有和不患有 SMI 的个体按疾病阶段分层的癌症发病率和随后的死亡率进行了比较。 Cox 回归用于估计发病率比 (IRR) 和死亡率比 (MRR)。对癌症进行全面检查并按主要病因进行分组。结果：有 SMI 的男性总体癌症发病率低于无 SMI 的男性； IRR = 0.89（95% CI：0.85-0.94），但患有 SMI 和不患有 SMI 的女性的比率相似； IRR = 1.03（95% CI：0.99-1.07）。患有 SMI 的人的总体死亡率高于没有 SMI 的人；男性 MRR = 1.56 (95% CI: 1.48-1.64)，女性 MRR = 1.49 (95% CI: 1.43-1.56)。按肿瘤分期和病因分层时，发病率和死亡率的估计值相似。结论：我们发现，与没有 SMI 的男性相比，患有 SMI 的男性的癌症发病率较低，两组女性的发病率相似。患有 SMI 的两性患者随后的死亡率均较高。死亡率过高并不能用癌症晚期来解释；未来的研究应该评估癌症治疗和康复的效果。 (C) 2018 Elsevier B.V. 保留所有权利。
Background: Excess mortality in individuals with severe mental illness (SMI) is often explained by physical comorbidity and suboptimal healthcare. Cancer is a prevalent cause of death, and tumour stage at diagnosis is a strong predictor of mortality. We aimed to study cancer incidence, disease stage at diagnosis and subsequent mortality in individuals with SMI compared to individuals without SMI.Methods: The entire Danish population was followed in 1978-2013 using nationwide registries. Cancer incidence and subsequent mortality stratified by disease stage were compared in individuals with and without SMI. Cox regression was used to estimate incidence rate ratios (IRR) and mortality rate ratios (MRR). Cancer was examined overall and grouped by major aetiological factors.Results: The overall cancer incidence rate was lower in males with SMI than in males without SMI; IRR = 0.89 (95% CI: 0.85-0.94), but rates were similar in females with SMI and without SMI; IRR = 1.03 (95% CI: 0.99-1.07). The overall mortality rate was higher in individuals with SMI than those without; MRR = 1.56 (95% CI: 1.48-1.64) for males and MRR = 1.49 (95% CI: 1.43-1.56) for females. Incidence rates and mortality rates showed similar estimates when stratified by tumour stage and aetiology.Conclusions: We found lower cancer incidence inmales with SMI compared to males without SMI and similar incidence in the two groups of women. Higher subsequent mortality was found in both sexes with SMI. The excess mortality was not explained by more advanced stages of cancer; future studies should evaluate the effect of cancer treatment and rehabilitation. (C) 2018 Elsevier B.V. All rights reserved.