Department of Non-Communicable Disease Epidemiology, Inequalities in Cancer Outcomes Network, London School of Hygiene and Tropical Medicine, London, UK.
Non-Communicable Disease and Cancer Epidemiology Group, Instituto de Investigación Biosanitaria de Granada (ibs. GRANADA), Granada, Spain.
BMC Cancer. 2021 Sep 24;21(1):1048. doi: 10.1186/s12885-021-08801-9.
Chronic diseases often occur simultaneously and tend to be associated with adverse health outcomes, but limited research has been undertaken to understand their role in lung cancer mortality. Therefore, this study aims to describe the prevalence and patterns of having one (comorbidity) or ≥ 2 chronic diseases (multimorbidity) among lung cancer patients in Spain, and to examine the association between comorbidity or multimorbidity and short-term mortality risk at six months after cancer diagnosis.
In this population-based cohort study, data were drawn from two Spanish population-based cancer registries, Girona and Granada, and electronic health records. We identified 1259 adult lung cancer patients, diagnosed from 1st January 2011 to 31st December 2012. We identified the most common patterns of individual comorbidities and their pairwise correlations. We used a flexible parametric modelling approach to assess the overall short-term mortality risk 6 months after cancer diagnosis by levels of comorbidity after adjusting for age, sex, smoking status, province of residence, surgery, cancer stage, histology, and body mass index.
We found high prevalence of comorbidity in lung cancer patients, especially among the elderly, men, those diagnosed with advanced-stage tumours, smokers, and obese patients. The most frequent comorbidities were chronic obstructive pulmonary disease (36.6%), diabetes (20.7%) and heart failure (16.8%). The strongest pairwise correlation was the combination of heart failure with renal disease (r = 0.20, p < 0.01), and heart failure with diabetes (r = 0.16, p < 0.01). Patients with either one or two or more comorbidities had 40% higher overall mortality risk than those without comorbidities (aHR for comorbidity: 1.4, 95%CI: 1.1-1.7; aHR for multimorbidity: 1.4, 95%CI: 1.1-1.8), when relevant confounding factors were considered.
The presence of comorbid diseases, rather than the number of comorbidities, was associated with increasing the risk of short-term lung cancer mortality in Spain. Comorbidity was a consistent and independent predictor of mortality among lung cancer patients, six months after diagnosis. The most common comorbid conditions were age-, obesity- and tobacco-related diseases. Our findings highlight the need to develop targeted preventive interventions and more personalised clinical guidelines to address the needs of lung cancer patients with one or more comorbidities in Spain.
慢性病常同时发生，并可能与不良健康结局相关，但对于其在肺癌死亡率中的作用，相关研究仍十分有限。因此，本研究旨在描述西班牙肺癌患者患有一种（共病）或≥两种慢性疾病（多种共病）的患病率和模式，并探讨共病或多种共病与癌症诊断后 6 个月短期死亡率风险之间的关系。
在这项基于人群的队列研究中，数据来自西班牙两个基于人群的癌症登记处——赫罗纳和格拉纳达，以及电子健康记录。我们确定了 1259 名成年肺癌患者，他们于 2011 年 1 月 1 日至 2012 年 12 月 31 日被诊断为肺癌。我们确定了个体共病的最常见模式及其两两相关性。我们使用灵活的参数建模方法，通过调整年龄、性别、吸烟状况、居住省份、手术、癌症分期、组织学和体重指数，评估癌症诊断后 6 个月共病水平与短期死亡率之间的总体风险。
我们发现肺癌患者的共病患病率很高，尤其是在老年人、男性、晚期肿瘤患者、吸烟者和肥胖患者中。最常见的共病是慢性阻塞性肺疾病（36.6%）、糖尿病（20.7%）和心力衰竭（16.8%）。最强的两两相关性是心力衰竭与肾脏疾病的组合（r=0.20，p<0.01），以及心力衰竭与糖尿病的组合（r=0.16，p<0.01）。与无共病的患者相比，患有一种或两种或更多种共病的患者总体死亡率风险高 40%（共病的调整后 HR：1.4，95%CI：1.1-1.7；多种共病的调整后 HR：1.4，95%CI：1.1-1.8），当考虑到相关混杂因素时。
在西班牙，存在共病而非共病数量与短期肺癌死亡率的增加相关。在癌症诊断后 6 个月时，共病是肺癌患者死亡的一致且独立的预测因子。最常见的共病是与年龄、肥胖和烟草相关的疾病。我们的研究结果强调需要制定有针对性的预防干预措施和更个性化的临床指南，以满足西班牙有或无共病的肺癌患者的需求。
