Cause-specific mortality among Veterans with serious mental illness lost to follow-up
VA National Serious Mental Illness Treatment Resource and Evaluation Center and VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA General hospital psychiatry
(Impact Factor: 2.61).
07/2012; 34(6):651-3. DOI: 10.1016/j.genhosppsych.2012.05.014
Although reduced care engagement has been linked to increased mortality for persons with serious mental illness (SMI), there have been limited investigations into specific mortality causes for this group. This study evaluates the effects of care disengagement on mortality cause and time until death in Veterans with SMI.
A total of 3300 Veterans with SMI lost to Veterans Affairs care for more than 1 year were contacted by providers who attempted treatment reengagement. Fisher's Exact Tests evaluated associations between mortality cause and reengagement status, and a Cox proportional hazard model evaluated the association between reengagement and survival.
During the study, 146 (4.6%) patients died. A lack of reengagement was associated with increased noninjury death [odds ratio (OR)=1.64], increased cancer-based mortality (OR=4.76) and an average of 97.4 fewer days of life.
Care reengagement may support medical care management and reduce preventable medical mortality for Veterans with SMI.
Available from: Jackson S Musuuza
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The objective was to compare patterns of site-specific cancer mortality in a population of individuals with and without mental illness.
This was a cross-sectional, population-based study using a linked data set comprised of death certificate data for the state of Ohio for the years 2004-2007 and data from the publicly funded mental health system in Ohio. Decedents with mental illness were those identified concomitantly in both data sets. We used age-adjusted standardized mortality ratios (SMRs) in race- and sex-specific person-year strata to estimate excess deaths for each of the anatomic cancer sites.
Overall, there was excess mortality from cancer associated with having mental illness in all the race/sex strata: SMR, 2.16 (95% CI, 1.85-2.50) for black men; 2.63 (2.31-2.98) for black women; 3.89 (3.61-4.19) for nonblack men; and 3.34 (3.13-3.57) for nonblack women. In all the race/sex strata except for black women, the highest SMR was observed for laryngeal cancer, 3.94 (1.45-8.75) in black men and 6.51 (3.86-10.35) and 6.87 (3.01-13.60) in nonblack men and women, respectively. The next highest SMRs were noted for hepatobiliary cancer and cancer of the urinary tract in all race/sex strata, except for black men.
Compared with the general population in Ohio, individuals with mental illness experienced excess mortality from most cancers, possibly explained by a higher prevalence of smoking, substance abuse, and chronic hepatitis B or C infections in individuals with mental illness. Excess mortality could also reflect late-stage diagnosis and receipt of inadequate treatment.
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ABSTRACT: Individuals with schizophrenia are a vulnerable population that has been relatively neglected in health disparities research. Despite having an equivalent risk of developing most cancers, patients with schizophrenia are more likely to die of cancer than the general population. Cancer care disparities are likely the result of patient-, provider-, and systems-level factors and influenced by the pervasive stigma of mental illness. Individuals with schizophrenia have higher rates of health behaviors linked with cancer mortality including cigarette smoking. They also have significant medical comorbidity, are less likely to have up-to-date cancer screening, and may present at more advanced stages of illness. Patients with schizophrenia may be less likely to receive chemotherapy or radiotherapy, have more postoperative complications, and have less access to palliative care. However, opportunities exist for the interdisciplinary team, including medical, surgical, and radiation oncologists; psychiatrists; and primary care physicians, to intervene throughout the continuum of cancer care to promote survival and quality of life. This review summarizes data on overall and cancer-specific mortality for individuals with schizophrenia and reviews specific disparities across the cancer care continuum of screening, diagnosis, treatment, and end-of-life care. Using a case, the authors illustrate clinical challenges for this population including communication, informed consent, and risk of suicide, and provide suggestions for care. Finally, recommendations for research to address the disparities in cancer care for individuals with schizophrenia are discussed. Despite significant challenges, with collaboration between oncology and mental health teams, individuals with schizophrenia can receive high-quality cancer care. Cancer 2013;. © 2013 American Cancer Society.
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