Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Department of Cardiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
JAMA Netw Open. 2020 Feb 5;3(2):e1921647. doi: 10.1001/jamanetworkopen.2019.21647.
Previous studies have suggested that patients with cancer may be at an increased risk of death from unintentional injury, but to our knowledge, no large studies have examined the rates of death from unintentional injury among patients with cancer.
To characterize the incidence of death from unintentional injury among patients with cancer in the United States.
DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study included patients diagnosed with a first primary cancer between January 1, 1973, and December 31, 2015, identified from the Surveillance, Epidemiology, and End Results (SEER) program data. Comparisons with the general US population were based on mortality data collected by the National Center for Health Statistics. Analyses were performed from February 1, 2019, to August 15, 2019.
Rates and standardized mortality ratios (SMRs) of death from unintentional injury among patients with cancer.
A total of 8 271 020 patients with cancer were included in this study (50.2% female; mean [SD] age, 63.0 [15.7] years). Among them, 40 599 deaths from unintentional injury were identified. The rates of death from unintentional injury were 81.90 per 100 000 person-years among patients with cancer and 51.21 per 100 000 person-years in the corresponding US general population. The SMR of death from unintentional injury was 1.60 (95% CI, 1.58-1.61). Higher rates of death from unintentional injury were associated with increasing age at diagnosis (≥80 years; rate ratio [RR], 2.91; 95% CI, 2.84-2.98; P < .001), male sex (RR, 1.69; 95% CI, 1.66-1.73; P < .001), American Indian or Alaskan Native population (RR, 1.48; 95% CI, 1.30-1.68; P < .001), and being unmarried (RR, 1.23; 95% CI, 1.18-1.28; P < .001). Rates of death from unintentional injury were the highest in patients with cancers of the liver (200.37 per 100 000 person-years), brain (175.04 per 100 000 person-years), larynx (148.78 per 100 000 person-years), and esophagus (144.98 per 100 000 person-years). The SMRs were the highest in the first month after cancer diagnosis.
This study found that the incidence of death from unintentional injury among patients with cancer was significantly higher than that in the general population in the United States. The rates of death from unintentional injury varied by age, sex, race/ethnicity, marital status, cancer site, disease stage, and time since diagnosis. The findings suggest that death from unintentional injury among patients with cancer requires further attention and that initiatives to identify patients at risk and to develop targeted prevention strategies should be prioritized.
先前的研究表明，癌症患者可能面临更高的非故意伤害死亡风险，但据我们所知，尚未有大型研究调查癌症患者的非故意伤害死亡率。
描述美国癌症患者的非故意伤害死亡发生率。
设计、地点和参与者：本回顾性队列研究纳入了 1973 年 1 月 1 日至 2015 年 12 月 31 日期间在美国监测、流行病学和最终结果（SEER）项目数据中诊断出的首例原发性癌症患者。与一般美国人群的比较基于国家卫生统计中心收集的死亡率数据。分析于 2019 年 2 月 1 日至 2019 年 8 月 15 日进行。
癌症患者非故意伤害死亡的发生率和标准化死亡率比（SMR）。
本研究共纳入 8271020 例癌症患者（50.2%为女性；平均[SD]年龄为 63.0[15.7]岁）。其中，确定了 40599 例非故意伤害死亡。癌症患者的非故意伤害死亡率为 81.90/100000 人年，而相应的美国一般人群为 51.21/100000 人年。非故意伤害死亡的 SMR 为 1.60（95%CI，1.58-1.61）。随着诊断时年龄的增加（≥80 岁；比率比[RR]，2.91；95%CI，2.84-2.98；P<0.001）、男性（RR，1.69；95%CI，1.66-1.73；P<0.001）、美国印第安人或阿拉斯加原住民（RR，1.48；95%CI，1.30-1.68；P<0.001）和未婚（RR，1.23；95%CI，1.18-1.28；P<0.001），非故意伤害死亡率较高。癌症患者的非故意伤害死亡率最高的是肝癌（200.37/100000 人年）、脑癌（175.04/100000 人年）、喉癌（148.78/100000 人年）和食管癌（144.98/100000 人年）。在癌症诊断后的第一个月，SMR 最高。
本研究发现，美国癌症患者的非故意伤害死亡率明显高于一般人群。非故意伤害死亡率因年龄、性别、种族/民族、婚姻状况、癌症部位、疾病阶段和诊断后时间而异。研究结果表明，癌症患者的非故意伤害死亡需要进一步关注，应优先确定有风险的患者并制定有针对性的预防策略。
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