癌症诊断前接受抗抑郁药治疗人群的癌症死亡率：一项基于人群的队列研究。
Cancer Mortality in People Treated with Antidepressants before Cancer Diagnosis: A Population Based Cohort Study.
作者信息
Sun Yuelian, Vedsted Peter, Fenger-Grøn Morten, Wu Chun Sen, Bech Bodil Hammer, Olsen Jørn, Benros Michael Eriksen, Vestergaard Mogens
机构信息
Research Unit for General Practice, Department of Public Health, Aarhus University, Aarhus, Denmark; Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark.
Research Unit for General Practice, Department of Public Health, Aarhus University, Aarhus, Denmark.
出版信息
PLoS One. 2015 Sep 14;10(9):e0138134. doi: 10.1371/journal.pone.0138134. eCollection 2015.
BACKGROUND
Depression is common after a cancer diagnosis and is associated with an increased mortality, but it is unclear whether depression occurring before the cancer diagnosis affects cancer mortality. We aimed to study cancer mortality of people treated with antidepressants before cancer diagnosis.
METHODS AND FINDINGS
We conducted a population based cohort study of all adults diagnosed with cancer between January 2003 and December 2010 in Denmark (N = 201,662). We obtained information on cancer from the Danish Cancer Registry, on the day of death from the Danish Civil Registry, and on redeemed antidepressants from the Danish National Prescription Registry. Current users of antidepressants were defined as those who redeemed the latest prescription of antidepressant 0-4 months before cancer diagnosis (irrespective of earlier prescriptions), and former users as those who redeemed the latest prescription five or more months before cancer diagnosis. We estimated an all-cause one-year mortality rate ratio (MRR) and a conditional five-year MRR for patients who survived the first year after cancer diagnosis and confidence interval (CI) using a Cox proportional hazards regression model. Overall, 33,111 (16.4%) patients redeemed at least one antidepressant prescription in the three years before cancer diagnosis of whom 21,851 (10.8%) were current users at the time of cancer diagnosis. Current antidepressant users had a 32% higher one-year mortality (MRR = 1.32, 95% CI: 1.29-1.35) and a 22% higher conditional five-year mortality (MRR = 1.22, 95% CI: 1.17-1.26) if patients survived the first year after the cancer diagnosis than patients not redeeming antidepressants. The one-year mortality was particularly high for patients who initiated antidepressant treatment within four months before cancer diagnosis (MRR = 1.54, 95% CI: 1.47-1.61). Former users had no increased cancer mortality.
CONCLUSIONS
Initiation of antidepressive treatment prior to cancer diagnosis is common and is associated with an increased mortality.
背景
癌症诊断后抑郁症很常见，且与死亡率增加相关，但尚不清楚癌症诊断前出现的抑郁症是否会影响癌症死亡率。我们旨在研究癌症诊断前接受抗抑郁药治疗的人群的癌症死亡率。
方法与结果
我们对2003年1月至2010年12月在丹麦被诊断患有癌症的所有成年人进行了一项基于人群的队列研究（N = 201,662）。我们从丹麦癌症登记处获取癌症信息，从丹麦民事登记处获取死亡日期信息，并从丹麦国家处方登记处获取已兑现的抗抑郁药信息。抗抑郁药的当前使用者定义为在癌症诊断前0 - 4个月兑现了最新抗抑郁药处方的人（无论早期处方情况如何），既往使用者定义为在癌症诊断前五个或更多个月兑现了最新处方的人。我们使用Cox比例风险回归模型估计了癌症诊断后存活一年的患者的全因一年死亡率比（MRR）和条件五年MRR以及置信区间（CI）。总体而言，33,111名（16.4%）患者在癌症诊断前三年至少兑现了一张抗抑郁药处方，其中21,851名（10.8%）在癌症诊断时为当前使用者。如果患者在癌症诊断后存活一年，当前抗抑郁药使用者的一年死亡率高32%（MRR = 1.32，95% CI：1.29 - 1.35），条件五年死亡率高22%（MRR = 1.22，95% CI：1.17 - 1.26），而未兑现抗抑郁药的患者则不然。对于在癌症诊断前四个月内开始抗抑郁药治疗的患者，一年死亡率特别高（MRR = 1.54，95% CI：1.47 - 1.61）。既往使用者的癌症死亡率没有增加。
结论
癌症诊断前开始抗抑郁治疗很常见，且与死亡率增加相关。
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