Temporal order of cancers and mental disorders in an adult population

Abstract

BackgroundPopulation-based examination of comorbidity is an emerging field of study.AimsThe purpose of the present population level study is to expand our understanding of how cancer and mental illness are temporally associated.MethodA sample of 83 648 056 physician billing records for 664 838 (56% female) unique individuals over the age of 18 was stratified on ages 19–49 years and 50+ years, with temporal order of mental disorder and cancer forming the basis of comparison.ResultsMental disorders preceded cancers for both genders within each age strata. The full range of cancers and mental disorders preceding or following each pivot ICD class are described in terms of frequency of diagnosis and duration in days, with specific examples illustrated.ConclusionsThe temporal comorbidity between specific cancers and mental disorders may be useful in screening or clinical planning and may represent indicators of disease mechanism that warrant further screening or investigation.Declaration of interestNone.

A 16-Year Cohort Analysis of Autism Spectrum Disorder-Associated Morbidity in a Pediatric Population

“…The recently published papers from this population dataset have been informative in terms of signaling the importance of considering mental disorders in relation to physical or biomedical disorders ( 29 – 31 , 34 ) and, in the cases of ulcerative colitis and cancer, identifying potential mechanism underlining individual vulnerability (diathesis) or the confounding of the physical or biomedical disease with treatment, or both ( 29 , 31 ). For example, in both cancers and ulcerative colitis, neuroleptics may disrupt immunological cell-cell communication and represent long-term adverse effects associated with mental disease treatment.…”

“…The sample from which the sub-sample for this study 2 derives and the methods employed in this study have been described in detail ( 28 – 31 , 34 ). This study extends previous work in describing the specific disorders arising significantly before or after index ASD, the pivot diagnosis.…”

“…The database employed in the present study represented the formal physician diagnoses (~90 Million) for the health service seeking population in the Calgary Health Zone (~0.75 Million). As noted in previously published limitations respecting this database, over-diagnosis of common disorders, under-diagnosis of rare disorders and misdiagnosis are all likely represented, albeit minimally, in the data ( 29 , 31 ). Also, the algorithms applied to the data were developed specifically to examine the temporal associations of the diagnosed diseases and disorders.…”

“…The results point to some potential possibilities in terms of mechanism, yet there is no possibility that studies focusing only on associative morbidity are conclusive. As with the studies that illustrate a potential confounding of treatment with outcome diagnoses such as ulcerative colitis or cancer ( 29 , 31 ), confounding exists between epigenetics, individual differences, diathesis, and, importantly, long-term unstudied adverse effects of treatment. While less likely to be the case with diseases, such as ulcerative colitis, the results of this population-based study, where ASD diagnosis alone is the key variable, must be considered as speculative.…”

“…Accompanying updated definitions aiding the conceptualization of morbidity is the advantage of access to large databases, such as the one on which present study and similar studies have been based ( 29 – 31 ). The 16-year database has been the source of numerous publications related to identifying key relationships between biomedical, physical, and mental disorders, in addition to the influence of the temporal occurrence of particular classes of disorders (e.g., mental disorders) in relationship to serious biomedical and somatic disorders ( 28 – 33 ).…”