心理健康状况人群的急诊结肠癌诊断：意大利北部一项基于人群的队列研究
Emergency colon cancer diagnosis in people with mental health conditions: a population-based cohort study in northern Italy.
作者信息
Pennisi Flavia, Buzzoni Carlotta, Gervasi Federico, Russo Antonio Giampiero, Renzi Cristina
机构信息
Vita-Salute San Raffaele University Faculty of Medicine and Surgery, Milan, Italy.
Department of Public Health, Experimental and Forensic Medicine Pavia, University of Pavia, Pavia, Lombardia, Italy.
出版信息
BMJ Ment Health. 2025 Jul 1;28(1):e301733. doi: 10.1136/bmjment-2025-301733.
BACKGROUND
Individuals with mental health conditions may experience disparity in cancer diagnosis and health outcomes. This study aims to examine diagnostic pathways and mortality in patients with colon cancer with pre-existing mental health conditions.
METHODS
A population-based cohort study on colon cancer cases diagnosed in 2014-2020 in the provinces of Milan and Lodi, using linked cancer registration and health data. We examined cancer diagnostic pathways (screening, emergency presentation (EP), inpatient/outpatient visits) and short-term mortality in patients with and without pre-existing mental health conditions, accounting for physical comorbidities and sociodemographic factors. Mental health conditions were systematically categorised into distinct groups according to the International Classification of Diseases, 10th Revision.
RESULTS
Out of 11 429 patients with colon cancer, 16.2% had a pre-existing mental health condition. Individuals with mental health conditions versus those without had a higher risk of cancer diagnosis following EP: 43.8% versus 33.8%, adjusted OR (aOR) 1.32, 95% CI 1.19 to 1.47. EP risk was higher for patients with diagnoses of dementia and related cognitive conditions (aOR 1.69, 95% CI 1.41 to 2.03), substance use/behavioural syndromes/personality-related conditions (aOR 1.92, 95% CI 1.34 to 2.75) and anxiety (aOR 1.44, 95% CI 1.16 to 1.79). The likelihood of screening-detected cancer was lower (4.6% vs 9.1%; aOR 0.78, 95% CI 0.60 to 0.99), especially for dementia and related cognitive conditions (aOR 0.27, 95% CI 0.08 to 0.86). Short-term mortality was higher in patients with cancer with mental health conditions than in those without.
CONCLUSION
Mental health conditions were associated with a lower likelihood of screening and a higher risk of emergency cancer diagnosis. Tailored strategies are warranted to enhance cancer diagnosis for the non-negligible group of individuals with mental health conditions.
背景
患有精神疾病的个体在癌症诊断和健康结局方面可能存在差异。本研究旨在探讨患有既往精神疾病的结肠癌患者的诊断途径和死亡率。
方法
一项基于人群的队列研究，研究对象为2014年至2020年在米兰和洛迪省诊断出的结肠癌病例，使用了关联的癌症登记和健康数据。我们研究了有无既往精神疾病的患者的癌症诊断途径（筛查、急诊就诊、住院/门诊就诊）和短期死亡率，并考虑了身体合并症和社会人口学因素。根据《国际疾病分类》第十版，将精神疾病系统地分为不同类别。
结果
在11429例结肠癌患者中，16.2%患有既往精神疾病。患有精神疾病的个体与未患精神疾病的个体相比，急诊就诊后癌症诊断风险更高：分别为43.8%和33.8%，调整后的比值比（aOR）为1.32，95%置信区间为1.19至1.47。痴呆及相关认知障碍患者（aOR 1.69，95%置信区间1.41至2.03）、物质使用/行为综合征/人格相关障碍患者（aOR 1.92，95%置信区间1.34至2.75）和焦虑症患者（aOR 1.44，95%置信区间1.16至1.79）的急诊就诊风险更高。筛查发现癌症的可能性较低（4.6%对9.1%；aOR 0.78，95%置信区间0.60至0.99），尤其是痴呆及相关认知障碍患者（aOR 0.27，95%置信区间0.08至0.86）。患有精神疾病的癌症患者的短期死亡率高于未患精神疾病的患者。
结论
精神疾病与筛查可能性较低和癌症急诊诊断风险较高相关。对于患有精神疾病的不可忽视的人群，需要制定针对性策略以加强癌症诊断。
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