Unfavorable cancer mortality‐to‐incidence ratios in patients with schizophrenia: A nationwide cohort study in Taiwan, 2000–2019

Cheng, Chu‐Syuan; Chen, Wen‐Yin; Chang, Hu‐Ming; Pan, Chun‐Hung; Su, Sheng‐Siang; Tsai, Shang‐Ying; Chen, Chiao‐Chicy; Kuo, Chian‐Jue

doi:10.1111/acps.13604

Cited by 4 publications

(1 citation statement)

References 61 publications

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“…A previous study reported a 2.9-fold higher risk of all-cause mortality in patients with schizophrenia compared to the general population, and a 1.6-fold higher risk compared to controls matched for physical diseases ( 36 ). Although several risk factors including cardiovascular diseases ( 37 ), stroke ( 37 , 38 ), smoking ( 39 ), physical fitness and inactivity ( 40 ), obesity ( 41 ), dyslipidemia ( 42 ), any cancer ( 43 ), and suicide ( 44 ) have been associated with all-cause mortality in patients with schizophrenia, the exact pathophysiological mechanisms have yet to be clarified.…”

Section: Discussionmentioning

confidence: 99%

Inter-relationships of risk factors and pathways associated with all-cause mortality in patients with chronic schizophrenia

Yu,

Lee,

Hsuan

et al. 2024

Front. Psychiatry

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IntroductionOf all psychiatric disorders, schizophrenia is associated with the highest risk of all-cause mortality. This study aimed to investigate independent risk factors for all-cause mortality in patients with chronic schizophrenia. In addition, the possible causal inter-relationships among these independent risk factors and all-cause mortality were also explored.MethodsWe conducted an analysis of 1,126 patients with chronic schizophrenia from our psychiatric department from April 2003 to August 2022, and retrospectively reviewed their medical records. The study endpoint was all-cause mortality. Baseline clinical characteristics including sociodemographic data, biochemical data, lifestyle factors, comorbidities and antipsychotic treatment were examined with Cox proportional hazards analysis.ResultsThe all-cause mortality rate was 3.9% (44 patients). Multivariate Cox regression analysis revealed that several factors were independently associated with all-cause mortality, including diabetes mellitus (DM), hypertension, heart failure, gastroesophageal reflux disease (GERD), peptic ulcer disease, ileus, underweight, fasting glucose, triglycerides, albumin, and hemoglobin. Structural equation modeling (SEM) analysis revealed that several factors had statistically significant direct effects on all-cause mortality. Heart failure, hypertension, underweight, age at onset, and ileus showed positive direct effects, while albumin and hemoglobin demonstrated negative direct effects. In addition, several factors had indirect effects on all-cause mortality. GERD indirectly affected all-cause mortality through ileus, and peptic ulcer disease had indirect effects through albumin and ileus. Ileus, underweight, DM, and hypertension also exhibited indirect effects through various pathways involving albumin, hemoglobin, and heart failure. Overall, the final model, which included these factors, explained 13% of the variability in all-cause mortality.DiscussionThese results collectively suggest that the presence of DM, hypertension, heart failure, GERD, peptic ulcer disease, ileus, and underweight, along with lower levels of albumin or hemoglobin, were independently associated with all-cause mortality. The SEM analysis further revealed potential causal pathways and inter-relationships among these risk factors contributing to all-cause mortality in patients with chronic schizophrenia.

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Section: Discussionmentioning

confidence: 99%

Inter-relationships of risk factors and pathways associated with all-cause mortality in patients with chronic schizophrenia

Yu,

Lee,

Hsuan

et al. 2024

Front. Psychiatry

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Cervical Cancer Screening Among Female Medicaid Beneficiaries With and Without Schizophrenia

Hwong,

Murphy,

Vittinghoff

et al. 2024

Schizophrenia Bulletin

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Background and Hypothesis In the United States, women with schizophrenia face challenges in receiving gynecologic care, but little is known about how cervical cancer screening rates vary across time or states in a publicly insured population. We hypothesized that women Medicaid beneficiaries with schizophrenia would be less likely to receive cervical cancer screening across the United States compared with a control population, and that women with schizophrenia and other markers of vulnerability would be least likely to receive screening. Study Design This retrospective cohort study used US Medicaid administrative data from across 44 states between 2002 and 2012 and examined differences in cervical cancer screening test rates among 283 950 female Medicaid beneficiaries with schizophrenia and a frequency-matched control group without serious mental illness, matched on age and race/ethnicity. Among women with schizophrenia, multivariable logistic regression estimated the odds of receiving cervical cancer screening using individual sociodemographics, comorbid conditions, and health care service utilization. Study Results Compared to the control group, women with schizophrenia were less likely to receive cervical cancer screening (OR = 0.76; 95% CI 0.75–0.77). Among women with schizophrenia, nonwhite populations, younger women, urban dwellers, those with substance use disorders, anxiety, and depression and those connected to primary care were more likely to complete screening. Conclusions Cervical cancer screening rates among US women Medicaid beneficiaries with schizophrenia were suboptimal. To address cervical cancer care disparities for this population, interventions are needed to prioritize women with schizophrenia who are less engaged with the health care system or who reside in rural areas.

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Sex and gender differences in cancer in individuals with severe mental disorders

Bajić,

Vuk-Pisk,

Filipčić

et al. 2024

Current Opinion in Psychiatry

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Purpose of review Although cancer incidence is similar between individuals with severe mental disorders (SMD) and the general population (GP), survival rates are lower, particularly in those with schizophrenia. While the scientific and medical communities acknowledge sex differences in cancer mechanisms, including risk factors and cancer types, less is known about sex and gender disparities in incidence, mortality, and care pathways among those with SMD. This review aims to explore these differences in cancer among individuals with SMD. Recent findings Current evidence on sex and gender differences in cancer care for SMD is limited. It is unclear how these factors affect cancer incidence and mortality in the SMD population, and if they correspond to those in the GP. The literature frequently omits detailed information on sex-based differences in SMD-related cancer rates, complicating conclusive analysis. Moreover, people with SMD experience significant challenges in accessing cancer screenings compared to the GP, and findings on sex and gender disparities in this context remain inconclusive. Summary This review emphasizes that while significant sex and gender-based differences in cancer mechanisms, incidence, and survival exist within the GP, they have not been fully integrated into clinical practice. It underscores the need of addressing these differences in cancer incidence, outcomes, mortality, and care pathways to enhance treatment for individuals with SMD.

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Unfavorable cancer mortality‐to‐incidence ratios in patients with schizophrenia: A nationwide cohort study in Taiwan, 2000–2019

Cited by 4 publications

References 61 publications

Inter-relationships of risk factors and pathways associated with all-cause mortality in patients with chronic schizophrenia

Inter-relationships of risk factors and pathways associated with all-cause mortality in patients with chronic schizophrenia

Cervical Cancer Screening Among Female Medicaid Beneficiaries With and Without Schizophrenia

Sex and gender differences in cancer in individuals with severe mental disorders

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