Relative incidence of common cancers in people with severe mental illness. Cohort study in the United Kingdom THIN primary care database

Osborn, David; Limburg, Heather; Walters, Kate; Petersen, Irene; King, Michael; Green, Jane; Watson, Joanna; Nazareth, Irwin

doi:10.1016/j.schres.2012.11.009

Cited by 43 publications

(37 citation statements)

References 21 publications

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“…Close to 400 research articles have been published using data from THIN, including previous research on CRC . The database has been shown to be representative of the UK population with regards to age, sex, and geographic distribution .…”

Section: Discussionsupporting

confidence: 61%

“…Close to 400 research articles have been published using data from THIN, 13 including previous research on CRC. 2,[22][23][24][25] The database has been shown to be representative of the UK population with regards to age, sex, and geographic distribution. 26 In addition, as part of the wider study from which this study arose, 2 we have found that the distribution of stage and site of the 3033 cases identified in THIN following manual review are broadly consistent with national data [27][28][29] supporting the representativeness to cases in the general population.…”

Section: Discussionmentioning

confidence: 99%

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Validity and completeness of colorectal cancer diagnoses in a primary care database in the United Kingdom

Soriano

Soriano‐Gabarró

Rodrı́guez

2015

Pharmacoepidemiol Drug Saf

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PurposeTo validate the recorded diagnoses of colorectal cancer (CRC) and identify false negatives in The Health Improvement Network (THIN) primary care database.MethodsWe conducted a validation study of incident CRC cases in THIN among patients aged 40–89 years from 2000–2011. CRC Read code entries (N = 3805) were verified by manual review of patients' electronic medical records (EMRs) including free‐text comments. Incident CRC cases in THIN ascertained following manual review were validated against two data sources deemed gold standards: (i) questionnaires sent to primary care practitioners (PCPs; for a random sample of 100 potential CRC cases), and (ii) Hospital Episode Statistics (HES) among linked practices. False negatives in THIN were identified by searching for International Classification of Diseases‐10 codes related to CRC in HES.ResultsOf 3805 CRC cases identified in THIN via Read codes, 3033 patients (80.0%) were considered definite cases after manual review of EMRs. The positive predictive value (PPV) of CRC Read codes was 86.0% after removing patients identified from THIN via a Read code for ‘fast track referral for suspected CRC’. The response rate from PCPs was 87.0% (n = 87), and the PPV of CRC in THIN was 100% based on PCP questionnaires. Using HES, the PPV for CRC in THIN was 97.9% (556/568), and false negative rate was 6.1% (36/592).ConclusionsCRC diagnostic Read codes in THIN have a high PPV, which is increased further following manual review of free‐text comments. The false negative rate of CRC diagnoses in THIN is low. © 2015 The Authors. Pharmacoepidemiology and Drug Safety published by John Wiley & Sons Ltd.

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Section: Discussionsupporting

confidence: 61%

Section: Discussionmentioning

confidence: 99%

Validity and completeness of colorectal cancer diagnoses in a primary care database in the United Kingdom

Soriano

Soriano‐Gabarró

Rodrı́guez

2015

Pharmacoepidemiol Drug Saf

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“…Forty-three cohort studies were included, of which 8 had a prospective design and 35 had a retrospective design, and 8 were nested case-control studies. Three reports [7,23,24] contained data on cancer comorbidity in patients with AD, 11 in PD [25,26,27,28,29,30,31,32,33,34,35], 9 in MS [32,36,37,38,39,40,41,42,43], 2 in ALS [32,44], 19 in SCZ [45,46,47,48,49,50,51,52,53,54,55,56,57,58,59,60,61,62,63], 6 in DS [3,64,65,66,67,68], 2 in HD [69,70] and 1 in ASD [71]. Patient data were collected from population-based registries in 38 of the studies, of which 13 were hospital based.…”

Section: Resultsmentioning

confidence: 99%

“…Sixteen studies [45,46,47,48,49,50,51,52,53,54,55,56,57,58,59,60] on 427,843 patients with SCZ showed no association between SCZ and cancer in general (ES = 0.98; 95% CI: 0.90-1.07; I 2 = 96.3%), with substantial between-study heterogeneity (Q statistic: p < 0.01; fig. 2).…”

Section: Resultsmentioning

confidence: 99%

Inverse and Direct Cancer Comorbidity in People with Central Nervous System Disorders: A Meta-Analysis of Cancer Incidence in 577,013 Participants of 50 Observational Studies

Catalá-López¹,

Suárez-Pinilla²,

Suárez-Pinilla³

et al. 2014

Psychother Psychosom

172

141

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Background: There is a lack of scientific consensus about cancer comorbidity in people with central nervous system (CNS) disorders. This study assesses the co-occurrence of cancers in patients with CNS disorders, including Alzheimer's disease (AD), amyotrophic lateral sclerosis (ALS), autism spectrum disorders, Down's syndrome (DS), Huntington's disease (HD), multiple sclerosis (MS), Parkinson's disease (PD) and schizophrenia (SCZ). Method: Comprehensive search in PubMed/MEDLINE, Scopus and ISI Web of Knowledge of the literature published before March 2013. We identified 51 relevant articles from 2,229 discrete references, 50 of which contained data suitable for quantitative synthesis (577,013 participants). Pooled effect sizes (ES) were calculated using multiple random-effects meta-analyses. Sources of heterogeneity and uncertainty were explored by means of subgroup and sensitivity analyses, respectively. Results: The presence of CNS disorders was associated with a reduced co-occurrence of cancer (ES = 0.92; 95% confidence interval, CI: 0.87-0.98; I² = 94.5%). A consistently lower overall co-occurrence of cancer was detected in patients with neurodegenerative disorders (ES = 0.80; 95% CI: 0.75- 0.86; I² = 82.8%), and in those with AD (ES = 0.32; 95% CI: 0.22-0.46; I² = 0.0%), PD (ES = 0.83; 95% CI: 0.76-0.91; I² = 80.0%), MS (ES = 0.91; 95% CI: 0.87-0.95; I² = 30.3%) and HD (ES = 0.53; 95% CI: 0.42-0.67; I² = 56.4%). Patients with DS had a higher overall co-occurrence of cancer (ES = 1.46; 95% CI: 1.08-1.96; I² = 87.9%). No association was observed between cancer and ALS (ES = 0.97; 95% CI: 0.76-1.25; I² = 0.0%) or SCZ (ES = 0.98; 95% CI: 0.90-1.07; I² = 96.3%). Patients with PD, MS and SCZ showed (a) higher co-occurrence of some specific cancers (e.g. PD with melanoma, MS with brain cancers and SCZ with breast cancer), and (b) lower co-occurrence of other specific cancers (e.g. lung, prostate and colorectal cancers in PD; lung and prostate cancers in MS; and melanoma and prostate cancer in SCZ). Conclusion: Increased and decreased co-occurrence of cancer in patients with CNS disorders represents an opportunity to discover biological and non-biological connections between these complex disorders.

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“…However, data are conflicting. Although several studies have shown an increased breast cancer risk and mortality rate among women with schizophrenia (e.g., , other studies have found a decreased or a statistically non‐significantly increased risk (e.g., (Table ). A recent meta‐analysis of observational studies in people with central nervous system disorders found that patients with schizophrenia showed a higher co‐occurrence of breast cancer (effect size = 1.25; 95% CI: 1.10‐1.42) .…”

Section: Neoplasmsmentioning

confidence: 99%

Effects of antipsychotics, antidepressants and mood stabilizers on risk for physical diseases in people with schizophrenia, depression and bipolar disorder

et al. 2015

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People with severe mental illness have a considerably shorter lifespan than the general population. This excess mortality is mainly due to physical illness. Next to mental illness-related factors, unhealthy lifestyle, and disparities in health care access and utilization, psychotropic medications can contribute to the risk of physical morbidity and mortality. We systematically reviewed the effects of antipsychotics, antidepressants and mood stabilizers on physical health outcomes in people with schizophrenia, depression and bipolar disorder. Updating and expanding our prior systematic review published in this journal, we searched MEDLINE (November 2009 -November 2014, combining the MeSH terms of major physical disease categories (and/or relevant diseases within these categories) with schizophrenia, major depressive disorder and bipolar disorder, and the three major psychotropic classes which received regulatory approval for these disorders, i.e., antipsychotics, antidepressants and mood stabilizers. We gave precedence to results from (systematic) reviews and meta-analyses wherever possible. Antipsychotics, and to a more restricted degree antidepressants and mood stabilizers, are associated with an increased risk for several physical diseases, including obesity, dyslipidemia, diabetes mellitus, thyroid disorders, hyponatremia; cardiovascular, respiratory tract, gastrointestinal, haematological, musculoskeletal and renal diseases, as well as movement and seizure disorders. Higher dosages, polypharmacy, and treatment of vulnerable (e.g., old or young) individuals are associated with greater absolute (elderly) and relative (youth) risk for most of these physical diseases. To what degree medication-specific and patient-specific risk factors interact, and how adverse outcomes can be minimized, allowing patients to derive maximum benefits from these medications, requires adequate clinical attention and further research.

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Relative incidence of common cancers in people with severe mental illness. Cohort study in the United Kingdom THIN primary care database

Cited by 43 publications

References 21 publications

Validity and completeness of colorectal cancer diagnoses in a primary care database in the United Kingdom

Validity and completeness of colorectal cancer diagnoses in a primary care database in the United Kingdom

Inverse and Direct Cancer Comorbidity in People with Central Nervous System Disorders: A Meta-Analysis of Cancer Incidence in 577,013 Participants of 50 Observational Studies

Effects of antipsychotics, antidepressants and mood stabilizers on risk for physical diseases in people with schizophrenia, depression and bipolar disorder

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