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Suicide and cardiovascular death after a cancer diagnosis
Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Clinical Epidemiology and Biostatistics Unit, Örebro University Hospital, Örebro, Sweden; Department of Epidemiology, Harvard School of Public Health, Boston, USA; Center of Public Health Sciences, University of Iceland, Reykjavík, Iceland.ORCID iD: 0000-0002-3649-2639
Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, USA; Department of Epidemiology, Harvard School of Public Health, Boston, USA.
Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
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2012 (English)In: New England Journal of Medicine, ISSN 0028-4793, E-ISSN 1533-4406, Vol. 366, no 14, p. 1310-1318Article in journal (Refereed) Published
Abstract [en]

Background: Receiving a diagnosis of cancer is a traumatic experience that may trigger immediate adverse health consequences beyond the effects of the disease or treatment.

Methods: Using Poisson and negative binomial regression models, we conducted a historical cohort study involving 6,073,240 Swedes to examine the associations between a cancer diagnosis and the immediate risk of suicide or death from cardiovascular causes from 1991 through 2006. To adjust for unmeasured confounders, we also performed a nested, self-matched case-crossover analysis among all patients with cancer who died from suicide or cardiovascular diseases in the cohort.

Results: As compared with cancer-free persons, the relative risk of suicide among patients receiving a cancer diagnosis was 12.6 (95% confidence interval [CI], 8.6 to 17.8) during the first week (29 patients; incidence rate, 2.50 per 1000 person-years) and 3.1 (95% CI, 2.7 to 3.5) during the first year (260 patients; incidence rate, 0.60 per 1000 person-years). The relative risk of cardiovascular death after diagnosis was 5.6 (95% CI, 5.2 to 5.9) during the first week (1318 patients; incidence rate, 116.80 per 1000 person-years) and 3.3 (95% CI, 3.1 to 3.4) during the first 4 weeks (2641 patients; incidence rate, 65.81 per 1000 person-years). The risk elevations decreased rapidly during the first year after diagnosis. Increased risk was particularly prominent for cancers with a poor prognosis. The case-crossover analysis largely confirmed results from the main analysis.

Conclusions: In this large cohort study, patients who had recently received a cancer diagnosis had increased risks of both suicide and death from cardiovascular causes, as compared with cancer-free persons. (Funded by the Swedish Council for Working Life and Social Research and others.).

Place, publisher, year, edition, pages
Walton, USA: Massachusetts Medical Society , 2012. Vol. 366, no 14, p. 1310-1318
National Category
Medical and Health Sciences Cancer and Oncology
Research subject
Medicine
Identifiers
URN: urn:nbn:se:oru:diva-24620DOI: 10.1056/NEJMoa1110307ISI: 000302343000008PubMedID: 22475594Scopus ID: 2-s2.0-84859393599OAI: oai:DiVA.org:oru-24620DiVA, id: diva2:545851
Funder
Forte, Swedish Research Council for Health, Working Life and WelfareSwedish Research CouncilThe Swedish Brain FoundationAvailable from: 2012-08-21 Created: 2012-08-21 Last updated: 2018-09-18Bibliographically approved

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Fall, Katja

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