Ma Wen, Wu Wentao, Fu Rong, Zheng Shuai, Bai Ruhai, Lyu Jun
Clinical Research Center, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, People's Republic of China.
School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, People's Republic of China.
Int J Gen Med. 2021 Mar 25;14:1107-1119. doi: 10.2147/IJGM.S300740. eCollection 2021.
Suicide rate is much higher in cancer patients than in general population. This study examined the suicide risk in survivors of primary solid tumor across 19 cancer sites considering risk coincident patterns based on area-based SES indicators.
A retrospective search of the SEER database was conducted. Independent risk factors for suicide were identified using the Cox proportional-hazards model. Exploratory factor analysis and cluster analysis were used to create coincident patterns of SES factors.
Suicide risk was higher for patients with a primary solid tumor who were older, male, white, unmarried, had no insurance, poorly differentiated, distant metastasis and did not undergo active treatment (especially surgery). The suicide risk was higher for patients living in areas with economic and education disadvantage, high levels of immigration and crowding, and high levels of residential instability. Concomitant presence of high economic and education disadvantage, high immigration and crowding levels and low residential instability, showed the highest risk of suicide.
In order to mitigate suicidal risk, clinicians should pay more attention to patients who are older, male, white, not married, high levels of cancer severity, not received active treatment (especially surgery), and having no insurance. Identifying coincident patterns of suicide help further screen high suicidal risk patients based on area-based socioeconomic status.
癌症患者的自杀率远高于普通人群。本研究基于地区社会经济地位指标，考虑风险重合模式，对19种癌症部位的原发性实体瘤幸存者的自杀风险进行了研究。
对监测、流行病学与最终结果（SEER）数据库进行回顾性检索。使用Cox比例风险模型确定自杀的独立危险因素。采用探索性因素分析和聚类分析来创建社会经济地位因素的重合模式。
原发性实体瘤患者中，年龄较大、男性、白人、未婚、无保险、低分化、有远处转移且未接受积极治疗（尤其是手术）的患者自杀风险更高。生活在经济和教育条件较差、移民和拥挤程度高、居住不稳定程度高的地区的患者自杀风险更高。经济和教育条件差、移民和拥挤程度高以及居住不稳定程度低同时存在，显示出自杀风险最高。
为降低自杀风险，临床医生应更加关注年龄较大、男性、白人、未婚、癌症严重程度高、未接受积极治疗（尤其是手术）且无保险的患者。识别自杀的重合模式有助于根据地区社会经济状况进一步筛查自杀风险高的患者。
