Risk of malignancy in patients with mental health problems

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Risk of malignancy in patients with mental health
problems

• Julia Hippisley-Cox
• Yana Vinogradova
• Carol Coupland
• Chris Parker
• SAPC, Keele
• July 2006

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Aims of presentation

• Overall
• Present analysis of study examining risk of
  cancer in patients with mental health problems

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Acknowledgements

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

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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

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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

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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

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Cases controls

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

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Study population QRESEARCH database

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

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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

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Statistical analysis

• Conditional logistic regression
• Odds ratios 95 CI
• Unadjusted adjusted

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Sample
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Confounding factors

• 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

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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

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Risk of cancer compared to general population
p lt 0.05 p lt 0.01
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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