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Risk of malignancy in patients with mental health problems

Risk of malignancy in patients with mental health problems. Julia Hippisley-Cox Yana Vinogradova Carol Coupland Chris Parker SAPC, Keele July 2006. Aims of presentation. Overall Present analysis of study examining risk of cancer in patients with mental health problems. Acknowledgements.

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Risk of malignancy in patients with mental health problems

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  1. Risk of malignancy in patients with mental health problems Julia Hippisley-Cox Yana Vinogradova Carol Coupland Chris Parker SAPC, Keele July 2006

  2. Aims of presentation • Overall • Present analysis of study examining risk of cancer in patients with mental health problems

  3. Acknowledgements • Co-author • Julia Hippisley-Cox • Carol Coupland • Chris Parker • QRESEARCH team • Mike Pringle • Mike Heaps • Gavin Langford • David Stables • EMIS and EMIS practices

  4. Funding body • Funded by Disability Rights Commission • Part of programme of work looking at health inequalities & outcomes for patients with serious mental health problems • Schizophrenia • Manic depression

  5. Background • No consistency in literature about cancer incidence in patients with mental health problems • Protective effect of schizophrenia • Increased cancer incidence and mortality • Fundamental differences in methodology • Cohorts are often restricted to hospital patients • No control for confounding factors

  6. Study design & setting • Nested case control study • Study period Jan 1995-July 2005 • Separate sets of matched cases and controls for each cancer • Breast • Colorectal • Gastroesophageal • Prostate • Respiratory

  7. Cases & controls • CASES • 1st ever record of cancer during 10 year study period • CONTROLS • 5 controls matched by • Age • Sex • Practice • Calendar year

  8. Study population: QRESEARCH database • Currently largest database in the UK • 537 UK practices • > 6 practices in every Strategic Health Authority (administrative area) • > 9 million patients including those who died, left and still registered • > 30 million person years of observation

  9. Data source: QRESEARCH database • Patient level consolidated database • Anonymised data • Longitudinal data for 15+ years • Derived from GP clinical records • Validated against external and internal measures • Industry independent

  10. Statistical analysis • Conditional logistic regression • Odds ratios + 95% CI • Unadjusted & adjusted

  11. Sample:

  12. Townsend score quintiles Body mass index Less than 25 kg/m2 25 to 29.9 kg/m2 30 kg/m2 or more BMI not recorded Smoking status Non-smoker Smoker not recorded Medications NSAIDs Statins Cox2 inhibitors Aspirin Hormone replaced therapy Contraceptive pill Antipsychotic drugs Antidepressants Confounding factors

  13. Methodological strengths • Large sample size and representative population • Data electronically collected –unlikely misclassification bias • Data collected before the diagnosis - no recall bias • Excluded diagnoses of mental health problems 12 months prior to cancer diagnosis – no information bias

  14. Risk of cancer compared to general population * p < 0.05 ** p < 0.01

  15. Conclusions • Risk of certain cancers differ among people with schizophrenia compared with general population • Patients with manic depression have similar cancer risk compared with general population

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