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背景收到癌症诊断对患者来讲是一种创伤性经历,其直接导致的不良健康后果可超过疾病或治疗产生的影响。方法我们利用泊松及负二项回归模型,进行一项含有6 073 240例瑞典人的历史性队列研究,以探究癌症诊断与1991—2006年期间自杀或心血管疾病死亡直接风险的关系。为了校正无法测定的混杂因素,对队列中因自杀或心血管疾病死亡的癌症患者进行巢式、自我匹配的病例交叉分析。结果与未患癌症的受试者相比,收到癌症诊断的患者在第1周内的自杀相对风险为12.6,95%CI(8.6,17.8)(29例患者,发生率为2.5例/1 000人年);第1年内为3.1,95%CI(2.7,3.5)(260例患者,发生率为0.6例/1 000人年)。诊断后第1周内的心血管疾病死亡相对风险为5.6,95%CI(5.2,5.9)(1 318例患者,发生率为116.80例/1 000人年);前4周内为3.3,95%CI(3.1,3.4)(2 641例患者,发生率为65.81例/1 000人年)。诊断后第1年内,升高的风险迅速降低。对于预后不良的癌症,风险的增加尤其明显。病例交叉分析很大程度上证实了先前主要分析得出的结果。结论本次大规模队列研究中,新近收到癌症诊断的患者与未患癌症的受试者相比,自杀及心血管疾病死亡风险均有所增加。
Background The receipt of a cancer diagnosis is a traumatic experience to the patient, which directly outweighs the adverse health consequences of the disease or treatment. METHODS We conducted a historic cohort study of 6,073,240 Swedish subjects using Poisson and negative binomial regression models to explore the relationship between cancer diagnosis and the direct risk of death from suicide or cardiovascular disease during 1991-2006. To correct unmeasured confounding factors, a case-by-case, crossover analysis of nested, self-matched cancer patients in the cohort who died of suicide or cardiovascular disease was performed. Results The relative risk of suicide among patients who received a cancer diagnosis at week 1 was 12.6 and 95% CIs (8.6 and 17.8), respectively (29 patients, a rate of 2.5 / 1 000 person-years); 3.1,95% CI (2.7,3.5) in the first year (260 patients, 0.6 per 1,000 person-years). The relative risk of death from cardiovascular disease during the first week after diagnosis was 5.6, 95% CI (5.2, 5.9) (1 318 patients, 116.80 deaths / 1,000 person-years); in the first 4 weeks, 3.3, 95 % CI (3.1,3.4) (2 641 patients, the incidence was 65.81 cases / 1,000 person-years). During the first year after diagnosis, the risk of rising rapidly decreases. The risk increases especially for cancers with poor prognosis. Case-by-case analysis largely confirmed the results of previous major analyzes. Conclusions In this large-scale cohort study, the risk of suicide and cardiovascular deaths was increased in newly received cancer diagnoses compared with those without cancer.