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Antidepressant use and mortality in Finland: a register-linkage study from a nationwide cohort.

https://arctichealth.org/en/permalink/ahliterature152280
Source
Eur J Clin Pharmacol. 2009 Jul;65(7):715-20
Publication Type
Article
Date
Jul-2009
Author
Jari Haukka
Martti Arffman
Timo Partonen
Sinikka Sihvo
Marko Elovainio
Jari Tiihonen
Jouko Lönnqvist
Ilmo Keskimäki
Author Affiliation
National Institute for Health and Welfare, Helsinki, Finland. jari.haukka@thl.fi
Source
Eur J Clin Pharmacol. 2009 Jul;65(7):715-20
Date
Jul-2009
Language
English
Publication Type
Article
Keywords
Adolescent
Antidepressive Agents - adverse effects - therapeutic use
Cause of Death
Cohort Studies
Data Collection
Female
Finland - epidemiology
Follow-Up Studies
Hospitalization
Humans
Male
Prescriptions
Registries
Risk assessment
Risk factors
Serotonin Uptake Inhibitors - adverse effects - therapeutic use
Suicide - psychology - statistics & numerical data
Young Adult
Abstract
It is generally acknowledged that depressed patients need specific attention during the first weeks after initiation of antidepressant (AD) treatment because of the increased risk of suicide.
The study population consisted of all individuals residing in Finland from 1999 to 2003 who had purchased a prescribed antidepressant at least once but had no preceding antidepressant prescription. Data sources were the National Prescription Register, the Causes of Death Register, Census Data of Statistics Finland, and the National Care Register. Follow-up started at the first purchase and ended at the end of 2003 or death. Data on prescriptions were used to construct contiguous treatment periods of follow-up time. Life-table analysis with Poisson regression was used to estimate risk ratios (RR) of antidepressant use with respect to all-cause mortality and to deaths from suicide.
Current AD use was associated with a lowered all-cause mortality (RR = 0.18, 95% CI = 0.18-0.19) compared with those who filled one previous prescription only. There was no difference in suicide mortality when any current antidepressant usage was compared to the one-prescription group. Current SSRI usage was associated with lower risk of suicide compared to the one-prescription or other antidepressant groups (RR 0.47, 0.38-0.59).
Current AD treatment is associated with decreased all-cause mortality rates in patients who have ever had AD treatment.
PubMed ID
19259654 View in PubMed
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Are there socioeconomic differences in outcomes of coronary revascularizations--a register-based cohort study.

https://arctichealth.org/en/permalink/ahliterature276411
Source
Eur J Public Health. 2015 Dec;25(6):984-9
Publication Type
Article
Date
Dec-2015
Author
Kristiina Manderbacka
Martti Arffman
Sonja Lumme
Ilmo Keskimäki
Source
Eur J Public Health. 2015 Dec;25(6):984-9
Date
Dec-2015
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Cohort Studies
Coronary Disease - epidemiology - surgery
Female
Finland - epidemiology
Healthcare Disparities - statistics & numerical data
Heart Diseases - epidemiology
Humans
Male
Middle Aged
Percutaneous Coronary Intervention - mortality - statistics & numerical data
Proportional Hazards Models
Reoperation - statistics & numerical data
Socioeconomic Factors
Treatment Outcome
Abstract
Earlier studies have reported socioeconomic differences in coronary heart disease incidence and mortality and in coronary treatment, but less is known about outcomes of care. We examined trends in income group differences in outcomes of coronary revascularizations among Finnish residents in 1998-2010.
First revascularizations for 45-84-year-old Finns were extracted from the Hospital Discharge Register in 1998-2009 and followed until 31 December 2010. Income was individually linked to them and adjusted for family size. We examined the risk of major adverse cardiac events (MACEs), coronary mortality and re-revascularization. We calculated age-standardized rates with direct method and Cox regression models.
Altogether 69 076 men and 27 498 women underwent revascularization during the study period. Among men [women] in the 1998 cohort, 41% [35%] suffered MACE during 29 days after the operation and 30% [28%] in the 2009 cohort. Myocardial infarction mortality within 1 year was 2% among both genders in both cohorts. Among men [women] 9% [14%] underwent revascularization within 1 year after the operation in 1998 and 12% [12%] in 2009. Controlling for age, co-morbidities, year, previous infarction and disease severity, an inverse income gradient was found in MACE incidence within 29 days and in coronary mortality. The excess MACE risk was 1.39 and excess mortality risk over 1.70 among both genders in the lowest income quintile. All income group differences remained stable from 1998 to 2010.
In health care, more attention should be paid to prevention of adverse outcomes among persons with low socioeconomic position undergoing revascularization.
PubMed ID
25958240 View in PubMed
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Change and persistence in healthcare inequities: access to elective surgery in Finland in 1992--2003.

https://arctichealth.org/en/permalink/ahliterature153333
Source
Scand J Public Health. 2009 Mar;37(2):131-8
Publication Type
Article
Date
Mar-2009
Author
Kristna Manderbacka
Martti Arffman
Alastair Leyland
Alison McCallum
Ilmo Keskimäki
Author Affiliation
Health Services Research, STAKES (National Research and Development Centre for Welfare and Health), Helsinki, Finland. kristiina.manderbacka@stakes.fi
Source
Scand J Public Health. 2009 Mar;37(2):131-8
Date
Mar-2009
Language
English
Publication Type
Article
Keywords
Adult
Aged
Aged, 80 and over
Female
Finland
Health Services Accessibility - statistics & numerical data - trends
Humans
Male
Middle Aged
Registries
Socioeconomic Factors
Surgical Procedures, Elective - methods - statistics & numerical data - trends
Abstract
Many countries experience persistent or increasing socioeconomic disparities in specialist care. This study examines the socioeconomic distribution of elective surgery from 1992 to 2003 in Finland.
Administrative registers were used to identify common elective procedures performed in all public and private hospitals in Finland in 1992-2003. Patients' individual sociodemographic data came from 1990-2003 census and employment statistics databases. First coronary revascularisation, hip and knee replacement, lumbar disc operation, cataract extraction, hysterectomy and prostatectomy on residents aged 25-84 years were analysed. Age-standardized procedure rates by income quintile were calculated for both genders, and concentration indices were developed and applied to age-standardized procedure rates in 5% income groups for each study year.
Most procedure rates increased during the study period. Three trends emerged: declining inequality for coronary revascularisations, an increase and then a decline in cataract extractions and primary knee replacements among men, and positive relationships between income and treatment for hysterectomy and lumbar disc operations.
Our results suggest that structural features - uneven availability, co-payments and plurality of provision - sustain inequity in access; decreasing inequities reflect directed service expansion. Increased attention to collective, prospective funding of primary and specialist ambulatory care is required to increase equity of access to elective surgery.
Notes
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PubMed ID
19124597 View in PubMed
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Changing patterns of secondary preventive medication among newly diagnosed coronary heart disease patients with diabetes in Finland: a register-based study.

https://arctichealth.org/en/permalink/ahliterature144891
Source
Scand J Public Health. 2010 May;38(3):317-24
Publication Type
Article
Date
May-2010
Author
Tuulikki Vehko
Kristna Manderbacka
Martti Arffman
Reijo Sund
Antti Reunanen
Ilmo Keskimäki
Author Affiliation
National Institute for Health and Welfare (THL), Helsinki, Finland. tuulikki.vehko@thl.fi
Source
Scand J Public Health. 2010 May;38(3):317-24
Date
May-2010
Language
English
Publication Type
Article
Keywords
Adrenergic beta-Antagonists - administration & dosage
Adult
Aged
Angiotensin II Type 1 Receptor Blockers - administration & dosage
Angiotensin-Converting Enzyme Inhibitors - administration & dosage
Coronary Disease - diagnosis - etiology - prevention & control
Diabetes Mellitus, Type 1 - complications - drug therapy
Diabetes Mellitus, Type 2 - complications - drug therapy
Drug Prescriptions - economics - statistics & numerical data
Drug Utilization - economics - statistics & numerical data
Female
Finland
Humans
Hypolipidemic Agents - administration & dosage
Male
Middle Aged
Practice Guidelines as Topic
Registries
Reimbursement Mechanisms
Secondary Prevention
Socioeconomic Factors
Abstract
Information on medicine use among coronary heart disease (CHD) patients with diabetes in unselected patient populations is scarce. This study examines the use of medication to prevent new cardiac events among newly diagnosed CHD patients with diabetes comparing them to patients without diabetes and examines socioeconomic differences in medicine use in these patient groups.
Data on CHD patients (43,501 men and 31,125 women) with or without diabetes were individually linked from nationwide registers (covering both patients treated in ambulatory and in hospital inpatient care). Age-standardised rates for medication use were calculated and differences between patient groups examined using Poisson regression.
beta-blocker use was high in all patient groups in 1997-2002, angiotensin-converting enzyme (ACE) inhibitor and angiotensin II antagonist use increased and remained higher among patients with diabetes. More than half of men and women with diabetes used ACE inhibitors and one out of five used angiotensin II antagonists in 2002. Lipid-lowering medication use increased, especially among women. In 1997-98 it was lower in lower socioeconomic groups; among men with diabetes the use remained lower than among others.
beta-blocker use was constant and ACE inhibitor and angiotensin II antagonist use increased. Lipid-lowering medication use increased considerably after a health insurance reform in 2000, in which elevated reimbursement of drug costs (75%) was extended to include all CHD patients with hyperlipidaemia.Socioeconomic differences in medication use disappeared after the reform. However, lipid-lowering medication use remained at a lower level among men with diabetes, suggesting that their treatment did not follow guidelines.
PubMed ID
20228159 View in PubMed
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Comparative observational study of mortality amenable by health policy and care between rural and urban Finland: no excess segregation of mortality in the capital despite its increasing residential differentiation.

https://arctichealth.org/en/permalink/ahliterature279122
Source
Int J Equity Health. 2016 Apr 05;15:59
Publication Type
Article
Date
Apr-05-2016
Author
Markku Lehikoinen
Martti Arffman
Kristiina Manderbacka
Marko Elovainio
Ilmo Keskimäki
Source
Int J Equity Health. 2016 Apr 05;15:59
Date
Apr-05-2016
Language
English
Publication Type
Article
Keywords
Adult
Aged
Alcohol-Related Disorders - epidemiology - mortality
Female
Finland - epidemiology
Health Policy
Health Services Accessibility - statistics & numerical data
Humans
Male
Middle Aged
Mortality
Myocardial Ischemia - epidemiology - mortality
Rural Population - statistics & numerical data
Socioeconomic Factors
Urban Population - statistics & numerical data
Abstract
Large cities are often claimed to display more distinct geographical and socioeconomic health inequalities than other areas due to increasing residential differentiation. Our aim was to assess whether geographical inequalities in mortality within the capital (City of Helsinki) both exceeded that in other types of geographical areas in Finland, and whether those differences were dependent on socioeconomic inequalities.
We analysed the inequality of distribution separately for overall, ischemic heart disease and alcohol-related mortality, and mortality amenable (AM) to health care interventions in 1992-2008 in three types of geographical areas in Finland: City of Helsinki, other large cities, and small towns and rural areas. Mortality data were acquired as secondary data from the Causes of Death statistics from Statistics Finland. The assessment of changing geographical differences over time, that is geographical inequalities, was performed using Gini coefficients. As some of these differences might arise from socioeconomic factors, we assessed socioeconomic differences with concentration indices in parallel to an analysis of geographical differences. To conclude the analysis, we compared the changes over time of these inequalities between the three geographical areas.
While mortality rates mainly decreased, alcohol-related mortality in the lowest income quintile increased. Statistically significant differences over time were found in all mortality groups, varying between geographical areas. Socioeconomic differences existed in all mortality groups and geographical areas. In the study period, geographical differences in mortality remained relatively stable but income differences increased substantially. For instance, the values of concentration indices for AM changed by 54 % in men (p?
Notes
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Cites: J Epidemiol Community Health. 2001 Jul;55(7):494-911413179
PubMed ID
27044484 View in PubMed
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The development of differences in hospital costs accross income groups in Finland from 1998 to 2010.

https://arctichealth.org/en/permalink/ahliterature277115
Source
Health Policy. 2014 Dec;118(3):354-62
Publication Type
Article
Date
Dec-2014
Author
Kristiina Manderbacka
Jutta Järvelin
Martti Arffman
Unto Häkkinen
Ilmo Keskimäki
Source
Health Policy. 2014 Dec;118(3):354-62
Date
Dec-2014
Language
English
Publication Type
Article
Keywords
Adult
Aged
Aged, 80 and over
Diagnosis-Related Groups
Female
Finland
Healthcare Disparities - trends
Hospital Costs - trends
Humans
Income - statistics & numerical data
Male
Middle Aged
Patient Admission - statistics & numerical data
Abstract
To quantify differences in hospital costs between socioeconomic groups and the development over time.
Register data on somatic specialised hospital admissions for patients aged between 25 and 84 in Finland in 1998-2010 were used with income data individually linked to them. The cost of an admission was calculated by multiplying the number of a patient's inpatient days by the inpatient day cost of the patient's DRG. We calculated age-standardised admission costs per resident and per user as well as costs per inpatient day and concentration indices separately for men and women.
Hospital admission costs reduced with increasing income. The difference between the extreme income quintiles was more than 50% throughout the study period, and this difference widened. However, the cost per inpatient day was more than 20% higher in the highest income group. The differences between income groups were the most prominent in disease categories involving surgery.
The growth between socioeconomic groups in hospital costs is presumably mainly due to increasing differences in morbidity. More attention needs to be paid to prevention of health inequalities and access to and content of primary care among low-income groups in order to decrease the need for hospitalisations.
PubMed ID
25129134 View in PubMed
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The effect of history of severe mental illness on mortality in colorectal cancer cases: a register-based cohort study.

https://arctichealth.org/en/permalink/ahliterature295284
Source
Acta Oncol. 2018 Jun; 57(6):759-764
Publication Type
Journal Article
Date
Jun-2018
Author
Kristiina Manderbacka
Martti Arffman
Sonja Lumme
Jaana Suvisaari
Ilmo Keskimäki
Aulikki Ahlgren-Rimpiläinen
Nea Malila
Eero Pukkala
Author Affiliation
a Health and Social Systems Research Unit , National Institute for Health and Welfare , Helsinki , Finland.
Source
Acta Oncol. 2018 Jun; 57(6):759-764
Date
Jun-2018
Language
English
Publication Type
Journal Article
Keywords
Adult
Aged
Cohort Studies
Colorectal Neoplasms - mortality - psychology
Comorbidity
Female
Finland
Humans
Kaplan-Meier Estimate
Male
Mental Disorders - complications
Middle Aged
Proportional Hazards Models
Registries
Abstract
While the link between mental illness and cancer survival is well established, few studies have focused on colorectal cancer. We examined outcomes of colorectal cancer among persons with a history of severe mental illness (SMI).
We identified patients with their first colorectal cancer diagnosis in 1990-2013 (n?=?41,708) from the Finnish Cancer Registry, hospital admissions due to SMI preceding cancer diagnosis (n?=?2382) from the Hospital Discharge Register and deaths from the Causes of Death statistics. Cox regression models were used to study the impact on SMI to mortality differences.
We found excess colorectal cancer mortality among persons with a history of psychosis and with substance use disorder. When controlling for age, comorbidity, stage at presentation and treatment, excess mortality risk among men with a history of psychosis was 1.72 (1.46-2.04) and women 1.37 (1.20-1.57). Among men with substance use disorder, the excess risk was 1.22 (1.09-1.37).
Understanding factors contributing to excess mortality among persons with a history of psychosis or substance use requires more detailed clinical studies and studies of care processes among these vulnerable patient groups. Collaboration between patients, mental health care and oncological teams is needed to improve outcomes of care.
PubMed ID
29363989 View in PubMed
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Effect of stage, comorbidities and treatment on survival among cancer patients with or without mental illness.

https://arctichealth.org/en/permalink/ahliterature292357
Source
Br J Psychiatry. 2017 Nov; 211(5):304-309
Publication Type
Journal Article
Date
Nov-2017
Author
Kristiina Manderbacka
Martti Arffman
Jaana Suvisaari
Aulikki Ahlgren-Rimpiläinen
Sonja Lumme
Ilmo Keskimäki
Eero Pukkala
Author Affiliation
Kristiina Manderbacka, PhD, Martti Arffmar, MSc, National Institute for Health and Welfare, Health and Social Systems Research, Helsinki, Finland; Jaana Suvisaari, PhD, Aulikki Ahlgren-Rimpiläinen, PhD, National Institute for Health and Welfare, Mental Health, Helsinki, Finland; Sonja Lumme MSc, National Institute for Health and Welfare, Health and Social Systems Research, Helsinki, Finland; Ilmo Keskimäki, PhD, National Institute for Health and Welfare, Health and Social Systems Research, Helsinki, Finland and Faculty of Social Sciences, University of Tampere, Finland; Eero Pukkala, PhD, Finnish Cancer Registry, Institute for Statistical and Epidemiological Cancer Research, Helsinki, and Faculty of Social Sciences, University of Tampere, Finland kristiina.manderbacka@thl.fi.
Source
Br J Psychiatry. 2017 Nov; 211(5):304-309
Date
Nov-2017
Language
English
Publication Type
Journal Article
Keywords
Aged
Comorbidity
Female
Finland - epidemiology
Humans
Male
Mental Disorders - epidemiology
Middle Aged
Neoplasm Staging
Neoplasms - mortality - pathology - therapy
Registries
Survival Analysis
Abstract
BackgroundEarlier research suggests poorer outcome of cancer care among people with severe mental illness (SMI).AimsTo assess the effect of stage at presentation, comorbidities and treatment on differences in survival among cancer patients with and without a history of SMI in Finland.MethodThe total population with a first cancer diagnosis in 1990-2013 was drawn from the Finnish Cancer Registry. Hospital admissions because of SMI and deaths were obtained from administrative registers. We calculated Kaplan-Meier estimates and Cox regression models to examine survival differences.ResultsWe found excess mortality in people with a history of psychotic and substance use disorders. Cancer stage and comorbidity did not explain mortality differences. Controlling for cancer treatment decreased the differences. The mortality gap between patients with psychosis and cancer patients without SMI increased over time.ConclusionsIntegrated medical and psychiatric care is needed to improve outcomes of cancer care among patients with SMI.
PubMed ID
28935659 View in PubMed
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Employment Status and Personal Income Before and After Onset of a Severe Mental Disorder: A Case-Control Study.

https://arctichealth.org/en/permalink/ahliterature308184
Source
Psychiatr Serv. 2020 03 01; 71(3):250-255
Publication Type
Journal Article
Research Support, Non-U.S. Gov't
Date
03-01-2020
Author
Christian Hakulinen
Marko Elovainio
Martti Arffman
Sonja Lumme
Kimmo Suokas
Sami Pirkola
Ilmo Keskimäki
Kristiina Manderbacka
Petri Böckerman
Author Affiliation
Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki (Hakulinen, Elovainio); National Institute for Health and Welfare, Helsinki (Hakulinen, Elovainio, Arffman, Lumme, Keskimäki, Manderbacka); Faculty of Social Sciences, Tampere University, Tampere, Finland (Suokas, Pirkola, Keskimäki); Pirkanmaa Hospital District, Tampere, Finland (Pirkola); School of Business and Economics, University of Jyväskylä, Jyväskylä, Finland (Böckerman); Labour Institute for Economic Research, Helsinki (Böckerman).
Source
Psychiatr Serv. 2020 03 01; 71(3):250-255
Date
03-01-2020
Language
English
Publication Type
Journal Article
Research Support, Non-U.S. Gov't
Keywords
Adolescent
Adult
Bipolar Disorder - economics - epidemiology
Case-Control Studies
Employment - economics - statistics & numerical data
Female
Finland - epidemiology
Humans
Income
Male
Middle Aged
Psychotic Disorders - economics - epidemiology
Schizophrenia - economics - epidemiology
Young Adult
Abstract
Individuals with severe mental disorders have an impaired ability to work and are likely to receive income transfer payments as their main source of income. However, the magnitude of this phenomenon remains unclear. Using longitudinal population cohort register data, the authors conducted a case-control study to examine the levels of employment and personal income before and after a first hospitalization for a serious mental disorder.
All individuals (N=50,551) who had been hospitalized for schizophrenia, other nonaffective psychosis, or bipolar disorder in Finland between 1988 and 2015 were identified and matched with five randomly selected participants who were the same sex and who had the same birth year and month. Employment status and earnings, income transfer payments, and total income in euros were measured annually from 1988 to 2015.
Individuals with serious mental disorders had notably low levels of employment before, and especially after, the diagnosis of a severe mental disorder. Their total income was mostly constituted of transfer payments, and this was especially true for those diagnosed as having schizophrenia. More than half of all individuals with a serious mental disorder did not have any employment earnings after they received the diagnosis.
The current study shows how most individuals in Finland depend solely on income transfer payments after an onset of a severe mental disorder.
PubMed ID
31722646 View in PubMed
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Excess mortality from breast cancer in female breast cancer patients with severe mental illness.

https://arctichealth.org/en/permalink/ahliterature307109
Source
Psychiatry Res. 2020 04; 286:112801
Publication Type
Journal Article
Research Support, Non-U.S. Gov't
Date
04-2020
Author
Aulikki J Ahlgrén-Rimpiläinen
Martti Arffman
Jaana Suvisaari
Kristiina Manderbacka
Sonja Lumme
Ilmo Keskimäki
Riikka Huovinen
Eero Pukkala
Author Affiliation
National Institute for Health and Welfare, Mental Health Unit, P.O. Box 30, Helsinki 00271, Finland. Electronic address: aulikki.ahlgren@thl.fi.
Source
Psychiatry Res. 2020 04; 286:112801
Date
04-2020
Language
English
Publication Type
Journal Article
Research Support, Non-U.S. Gov't
Keywords
Adult
Breast Neoplasms - complications - mortality - psychology
Case-Control Studies
Comorbidity
Female
Finland - epidemiology
Humans
Mental Disorders - diagnosis - mortality - psychology
Middle Aged
Mood Disorders - mortality - psychology
Registries
Severity of Illness Index
Substance-Related Disorders - mortality - psychology
Abstract
Women with a history of severe mental illness (SMI) have elevated breast cancer mortality. Few studies have compared cancer-specific mortality in women with breast cancer with or without SMI to reveal gaps in breast cancer treatment outcomes. We compared breast-cancer specific mortality in women with or without SMI and investigated effects of stage at presentation, comorbidity, and differences in cancer treatment. Women with their first breast cancer diagnosis in 1990-2013 (n = 80,671) were identified from the Finnish Cancer Registry, their preceding hospital admissions due to SMI (n = 4,837) from the Hospital Discharge Register and deaths from the Causes of Death Statistics. Competing risk models were used in statistical analysis. When controlling for age, year of cancer diagnosis, and comorbidity, breast cancer mortality was significantly elevated in patients with SMI. Relative mortality was highest in breast cancer patients with non-affective psychosis, partly explained by stage at presentation. Mortality was also significantly elevated in breast cancer patients with a substance use disorder and mood disorder. Patients with SMI received radiotherapy significantly less often than patients without SMI. Our findings emphasize the need to improve early detection of breast cancer in women with SMI and the collaboration between mental health care and oncological teams.
PubMed ID
32001004 View in PubMed
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27 records – page 1 of 3.