Department of Epidemiology and Biostatistics, School of Public Health, State University of New York at Albany, One University Place, Rensselaer, NY, United States.
Department of Epidemiology and Biostatistics, School of Public Health, State University of New York at Albany, One University Place, Rensselaer, NY, United States; Bureau of Cancer Epidemiology, New York State Department of Health, 150 Broadway, Ste 361, Albany, NY, United States.
Soc Sci Med. 2021 Feb;270:113643. doi: 10.1016/j.socscimed.2020.113643. Epub 2020 Dec 23.
We investigated the impact of preexisting mental illnesses on all-cause and cause-specific mortality among Medicaid-insured women diagnosed with breast cancer.
Data from the New York State Cancer Registry for 10,444 women diagnosed with breast cancer from 2004 to 2016 and aged <65 years at diagnosis were linked with Medicaid claims. Women were categorized as having depression or a severe mental illness (SMI) if they had at least three relevant diagnosis claims with at least one claim within three years prior to breast cancer diagnosis. SMI included schizophrenia, bipolar disorder, and other psychotic disorders. Estimated menopausal status was determined by age (premenopausal age <50; postmenopausal age ≥50). Hazard ratios (HR) and 95% confidence intervals (95%CI) were calculated with Cox proportional hazards regression, adjusting for potential confounders.
Preexisting SMI was associated with greater all-cause (HR = 1.36; 95%CI 1.18, 1.57) and cancer-specific (HR = 1.21; 95%CI 1.03, 1.44) mortality compared to those with no mental illnesses. No association was observed between preexisting depression and mortality. Among racial/ethnic subgroups, the association between SMI and all-cause mortality was observed among non-Hispanic white (HR = 1.47; 95%CI 1.19, 1.83) and non-Hispanic Asian/Pacific Islander (HR = 2.59; 95% 1.15, 5.87) women. Additionally, mortality hazards were greatest among women with preexisting SMI that were postmenopausal (HR = 1.49; 95%CI 1.25, 1.78), obese (HR = 1.58; 95%CI 1.26, 1.98), and had documented tobacco use (HR = 1.42; 95%CI 1.13, 1.78).
Women with preexisting SMI prior to breast cancer diagnosis have an elevated mortality hazard and should be monitored and treated by a coordinated cross-functional clinical team.
我们研究了在接受乳腺癌诊断的受医疗补助保险覆盖的女性中，先前存在的精神疾病对全因和特定原因死亡率的影响。
我们从纽约州癌症登记处获取了 2004 年至 2016 年间被诊断患有乳腺癌且年龄<65 岁的 10444 名女性的数据，并与医疗补助数据相关联。如果女性有至少三次与精神疾病相关的诊断记录，且至少有一次记录是在乳腺癌诊断前三年内，则将其归类为患有抑郁症或严重精神疾病（SMI）。SMI 包括精神分裂症、双相情感障碍和其他精神病性障碍。通过年龄（绝经前年龄<50 岁；绝经后年龄≥50 岁）来确定估计的绝经状态。使用 Cox 比例风险回归计算危险比（HR）和 95%置信区间（95%CI），并调整了潜在混杂因素。
与没有精神疾病的患者相比，先前存在的 SMI 与全因（HR=1.36；95%CI 1.18，1.57）和癌症特异性（HR=1.21；95%CI 1.03，1.44）死亡率更高相关。先前存在的抑郁症与死亡率之间没有关联。在种族/民族亚组中，在非西班牙裔白人和非西班牙裔亚裔/太平洋岛民女性中观察到 SMI 与全因死亡率之间存在关联（非西班牙裔白人：HR=1.47；95%CI 1.19，1.83；非西班牙裔亚裔/太平洋岛民：HR=2.59；95%CI 1.15，5.87）。此外，在先前患有 SMI 的绝经后（HR=1.49；95%CI 1.25，1.78）、肥胖（HR=1.58；95%CI 1.26，1.98）和有记录的烟草使用（HR=1.42；95%CI 1.13，1.78）的女性中，死亡率的危险最高。
在诊断乳腺癌之前患有先前存在的 SMI 的女性有更高的死亡危险，应通过跨功能协调的临床团队进行监测和治疗。
