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Risk of malignancy in patients with mental health problems

This presentation analyzes the risk of cancer in patients with mental health issues, highlighting disparities in cancer incidence. The study design, participant details, statistical analysis, and conclusions are discussed in depth.

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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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