Mammography Among Women With Severe Mental Illness: Exploring Disparities Through a Large Retrospective Cohort Study

Thomas, Melanie; James, Monique; Vittinghoff, Eric; Creasman, Jennifer M.; Schillinger, Dean; Mangurian, Christina

doi:10.1176/appi.ps.201600170

Cited by 21 publications

(24 citation statements)

References 36 publications

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“…Seventh, while a call for optimizing the synergy between mental health and primary care has been raised by the World Health Organization, (37) and consistently by other authors, (38)(39)(40), this strong rationale has only insufficiently translated into any actual change in clinical practice yet. Finally, diagnostic overshadowing, namely clinicians' attributing early somatic symptoms of cancer to underlying mental illness, may also explain why patients with mental illness undergo less medical exams (41).…”

Section: Discussionmentioning

confidence: 99%

Disparities in cancer screening in people with mental illness across the world versus the general population: prevalence and comparative meta-analysis including 4 717 839 people

Solmi

Firth

Miola

et al. 2020

The Lancet Psychiatry

131

130

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Background. Since people with mental illness more likely die from cancer, we assessed whether people with mental illness undergo less cancer screening versus the general population. Methods. Systematic review and meta-analysis of observational studies. Primary outcome was Odds Ratio (OR) of cancer screening in people with mental illness versus the general population. Secondary outcome was prevalence of cancer screening in mental illness. Sensitivity and subgroup analyses considered specific mental illness, diagnostic criteria, confounder adjustment, country/region, and program vs. opportunistic screening. Newcastle-Ottawa Scale was used to assess study quality. This study is registered with PROSPERO, number CRD42018114781.

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Section: Discussionmentioning

confidence: 99%

Disparities in cancer screening in people with mental illness across the world versus the general population: prevalence and comparative meta-analysis including 4 717 839 people

Solmi

Firth

Miola

et al. 2020

The Lancet Psychiatry

131

130

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“…Patients with SMIs have a well-documented increased rate of mortality mainly as a consequence of somatic illnesses, even when adjusting for stage of illness (Laursen 2011; Wahlbeck et al 2011). In accordance with these findings, a decreased proportion of patients with severe mental disorders were screened for breast cancer, cervical cancer or general somatic illness as compared to the background population (James et al 2017; Thomas et al 2018).…”

Section: Discussionmentioning

confidence: 89%

Mortality rate trends in patients diagnosed with schizophrenia or bipolar disorder: a nationwide study with 20 years of follow-up

Lomholt

Andersen

Sejrsgaard-Jacobsen

et al. 2019

Int J Bipolar Disord

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Background Patients with severe mental illness (SMI) have a reduced life expectancy of one to two decades as compared to the general population, with most years of life lost due to somatic diseases. Most previous studies on disorders constituting SMI, e.g. schizophrenia and bipolar disorder, have investigated the disorders separately and hence not compared the disorders in terms of mortality rates relative to the background population. Methods A register-based cohort study including the entire Danish population comparing mortality rates relative to the background population, controlling for age and sex, i.e. standardized mortality ratios (SMRs) in patients diagnosed with schizophrenia with those in patients diagnosed with bipolar disorder, during the study period from 1995 to 2014. Results The SMR of patients with SMI was significantly higher than one for each calendar year in the study period with an overall SMR of 4.58, 95% CI (4.48–4.69) in patients diagnosed with schizophrenia (n = 38,500) and of 2.57 (95% CI 2.49–2.65) in patients diagnosed with bipolar disorder (n = 23,092). When investigating time trends in SMR for schizophrenia and for bipolar disorder, respectively, an increase in SMR over time was shown with a mean increase of 0.03 per year for schizophrenia and 0.02 for bipolar disorder (p < 0.01 for both disorders). The ratio between SMR for schizophrenia and SMR for bipolar disorder for each calendar year over the study period was constant (p = 0.756). Conclusions Increasing SMRs over the last 20 years were found for both patients diagnosed with bipolar disorder and patients diagnosed with schizophrenia. Despite clear differences between the two disorders regarding SMRs, the increases in SMR over time were similar, which could suggest similar underlying factors influencing mortality rates in both disorders.

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“…While strong negative associations were found for drug abuse, paralysis, psychoses and metastatic cancer, strong positive associations were found for hypertension, rheumatoid arthritis/collagen vascular diseases and hypothyroidism. These findings seem plausible since severe morbidities, such as mental and neurological diseases as well as metastatic cancer may inhibit mammography screening participation (52–55). Diagnoses with less severe morbidities, by contrast, may result in an increased health awareness and thus an increased likelihood of participating in mammography screening.…”

Section: Discussionmentioning

confidence: 99%

Assessing and Explaining Geographic Variations in Mammography Screening Participation and Breast Cancer Incidence

Czwikla

Urbschat²,

Kieschke³

et al. 2019

Front. Oncol.

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Investigating geographic variations in mammography screening participation and breast cancer incidence help improve prevention strategies to reduce the burden of breast cancer. This study examined the suitability of health insurance claims data for assessing and explaining geographic variations in mammography screening participation and breast cancer incidence at the district level. Based on screening unit data (1,181,212 mammography screening events), cancer registry data (13,241 incident breast cancer cases) and claims data (147,325 mammography screening events; 1,778 incident breast cancer cases), screening unit and claims-based standardized participation ratios (SPR) of mammography screening as well as cancer registry and claims-based standardized incidence ratios (SIR) of breast cancer between 2011 and 2014 were estimated for the 46 districts of the German federal state of Lower Saxony. Bland-Altman analyses were performed to benchmark claims-based SPR and SIR against screening unit and cancer registry data. Determinants of district-level variations were investigated at the individual and contextual level using claims-based multilevel logistic regression analysis. In claims and benchmark data, SPR showed considerable variations and SIR hardly any. Claims-based estimates were between 0.13 below and 0.14 above (SPR), and between 0.36 below and 0.36 above (SIR) the benchmark. Given the limited suitability of health insurance claims data for assessing geographic variations in breast cancer incidence, only mammography screening participation was investigated in the multilevel analysis. At the individual level, 10 of 31 Elixhauser comorbidities were negatively and 11 positively associated with mammography screening participation. Age and comorbidities did not contribute to the explanation of geographic variations. At the contextual level, unemployment rate was negatively and the proportion of employees with an academic degree positively associated with mammography screening participation. Unemployment, income, education, foreign population and type of district explained 58.5% of geographic variations. Future studies should combine health insurance claims data with individual data on socioeconomic characteristics, lifestyle factors, psychological factors, quality of life and health literacy as well as contextual data on socioeconomic characteristics and accessibility of mammography screening. This would allow a comprehensive investigation of geographic variations in mammography screening participation and help to further improve prevention strategies for reducing the burden of breast cancer.

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Mammography Among Women With Severe Mental Illness: Exploring Disparities Through a Large Retrospective Cohort Study

Abstract: The findings can inform efforts to improve breast cancer screening among women with severe mental illness, such as targeted outreach to population subsets and colocation of primary care services in mental health treatment settings.

Cited by 21 publications

References 36 publications

Disparities in cancer screening in people with mental illness across the world versus the general population: prevalence and comparative meta-analysis including 4 717 839 people

Disparities in cancer screening in people with mental illness across the world versus the general population: prevalence and comparative meta-analysis including 4 717 839 people

Mortality rate trends in patients diagnosed with schizophrenia or bipolar disorder: a nationwide study with 20 years of follow-up

Assessing and Explaining Geographic Variations in Mammography Screening Participation and Breast Cancer Incidence

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