eprintid: 10153056 rev_number: 7 eprint_status: archive userid: 699 dir: disk0/10/15/30/56 datestamp: 2022-08-02 14:20:16 lastmod: 2022-08-02 14:20:16 status_changed: 2022-08-02 14:20:16 type: article metadata_visibility: show sword_depositor: 699 creators_name: Launders, N creators_name: Scolamiero, L creators_name: Osborn, DPJ creators_name: Hayes, JF title: Cancer rates and mortality in people with severe mental illness: Further evidence of lack of parity ispublished: pub divisions: C07 divisions: FH7 divisions: B02 divisions: UCL divisions: D79 keywords: Bipolar disorder, Psychosis, Schizophrenia, Severe mental illness, cancer note: Copyright © 2022 The Authors. Published by Elsevier B.V. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/). abstract: Background: Severe mental illness (SMI) is associated with poorer physical health, however the relationship between SMI and cancer is complex and previous study findings are inconsistent. Low incidence of cancer in those with SMI has been attributed to premature mortality, though evidence for this is lacking. We aimed to investigate the relationship between SMI and cancer incidence and mortality, and to assess the effect of premature mortality on cancer incidence rates. / Methods: In this UK-wide matched cohort study using primary care records we calculated incidence and mortality rates of all-cancer, and bowel, lung, breast or prostate cancer, in patients with SMI, compared to matched patients without SMI. We used competing risks regression to account for mortality from other causes. / Findings: 69,632 patients had an SMI diagnosis. The rate of all-cancer diagnoses was reduced in those with SMI (Hazard ratio (HR):0·95; 95%CI 0·93–0·98) compared to those without SMI, and particularly in those with schizophrenia (HR:0·82; 95%CI 0·77–0·88) compared to those without SMI. When accounting for the competing risk of premature mortality, incidence remained lower only in patients with schizophrenia. All-cause mortality after cancer was increased in the SMI group, and cancer-specific mortality was increased in those with schizophrenia (hazard ratio: 1.96; 95%CI 1.57–2.44). / Interpretation: Patients with schizophrenia have lower rates of cancer diagnosis but higher all-cause and cancer-specific mortality rates following diagnosis compared to those without SMI. Premature mortality does not explain these differences, suggesting the findings reflect barriers to cancer diagnosis and treatment, which need to be identified and addressed. date: 2022-08 date_type: published publisher: Elsevier BV official_url: https://doi.org/10.1016/j.schres.2022.07.008 oa_status: green full_text_type: pub language: eng primo: open primo_central: open_green verified: verified_manual elements_id: 1967692 doi: 10.1016/j.schres.2022.07.008 medium: Print-Electronic pii: S0920-9964(22)00280-8 lyricists_name: Osborn, David lyricists_name: Launders, Naomi lyricists_name: Hayes, Joseph lyricists_id: DPJOS02 lyricists_id: NJLAU54 lyricists_id: JFHAY18 actors_name: Flynn, Bernadette actors_id: BFFLY94 actors_role: owner full_text_status: public publication: Schizophrenia Research volume: 246 pagerange: 260-267 event_location: Netherlands issn: 0920-9964 citation: Launders, N; Scolamiero, L; Osborn, DPJ; Hayes, JF; (2022) Cancer rates and mortality in people with severe mental illness: Further evidence of lack of parity. Schizophrenia Research , 246 pp. 260-267. 10.1016/j.schres.2022.07.008 <https://doi.org/10.1016/j.schres.2022.07.008>. Green open access document_url: https://discovery.ucl.ac.uk/id/eprint/10153056/1/1-s2.0-S0920996422002808-main.pdf