The effect of history of severe mental illness on mortality in colorectal cancer cases: a register-based cohort study

Figures & data

Table 1. Basic background characteristics of population with first colorectal cancer in 1990–2013 in Finland, by sex and history of severe mental illness (SMI) category^a.

	Men				Women
	SUD^b	Psychosis	Mood disorder	No SMI^c	SUD^b	Psychosis	Mood disorder	No SMI^b
Cases
n	765	297	263	19 118	144	454	459	20 208
Age
(Mean)	65.4	65.5	66.3	67.5	64.3	69.1	71.5	70.2
Stage at presentation (%)
Local	29	30	28	32	28	26	32	32
Metastasized	53	50	48	52	47	55	51	50
Not known	17	20	24	17	24	19	17	18
Morphology (%)
Adenocarcinoma	83	86	86	85	77	82	81	80
Mucinous adeno-carcinoma	4	3	4	5	3	4	5	6
Other	13	11	10	10	20	16	14	14
Topography (%)
Colon	57	59	60	59	59	69	65	67
Rectum, anus and anal canal	43	41	40	41	41	31	35	33
Treatment (%)
Operative only	54	55	55	55	51	60	58	58
Operative + radiotherapy	10	7	8	8	9	5	5	6
Operative + chemotherapy	11	10	8	13	10	9	12	12
All three	7	4	6	8	5	5	4	6
Other	13	16	20	13	18	11	13	13
No treatment	5	7	3	4	6	10	7	6
Charlson’s index
(Mean)	0.19	0.19	0.20	0.21	0.14	0.16	0.18	0.17

^a Excludes cases diagnosed in autopsy.

^b Substance use disorder.

^c Severe mental illness.

Figure 1. Cumulative hazard of colorectal cancer mortality among Finnish men and women with their first cancer episode in 1990–2013 (lines cut at 14 years).

Table 2. Effect of history with severe mental illness (SMI) on colorectal cancer mortality among Finnish men and women in 1990–2013^a.

	Model I^b		Model II^c		Model III^d
	HR	95% CI	HR	95% CI	HR	95% CI
Men
No SMI	1.00		1.00		1.00
Substance use	1.21	1.08–1.36	1.22	1.09–1.37	1.22	1.09–1.37
Psychosis	1.58	1.33–1.86	1.73	1.46–2.04	1.72	1.46–2.04
Mood disorder	1.06	0.87–1.30	1.06	0.87–1.30	1.11	0.91–1.36
Generalised R^2	0.0544		0.2290		0.2777
Women
No SMI	1.00		1.00		1.00
Substance use	1.26	0.96–1.65	1.43	1.09–1.86	1.29	0.99–1.69
Psychosis	1.54	1.34–1.76	1.44	1.26–1.64	1.37	1.20–1.57
Mood disorder	1.11	0.96–1.28	1.12	0.97–1.29	1.10	0.95–1.27
Generalised R^2	0.1017		0.2638		0.3168

^aPeople without a history of SMI are used as the reference group.

^bModel I: controlling for age, year, cancer topography and morphology and comorbidities.

^cModel II: Model I + stage at presentation.

^dModel III: Model II + cancer treatment.

HR: hazard ratios; 95% CI: 95% confidence intervals.

Table 3. Hazard ratios (HR) and their 95% confidence intervals (CI) for five-year colorectal cancer mortality among incident cancer patients with a history of severe mental illness (SMI) in three time periods in 1990–2013.

	Year of cancer diagnosis
	1990–1994		1997–2001		2004–2008
	HR^a	95% CI	HR	95% CI	HR	95% CI
Men
No SMI	1.00		1.00		1.00
Substance use	1.53	1.11–2.09	1.32	1.02–1.70	1.11	0.89–1.39
Psychosis	1.77	1.11–2.82	1.79	1.26–2.55	1.74	1.17–2.58
Mood disorder	0.91	0.49–1.70	0.98	0.59–1.63	1.62	1.13–2.32
Women
No SMI	1.00		1.00		1.00
Substance use	1.26	0.56–2.81	1.28	0.74–2.21	2.79	1.69–4.57
Psychosis	1.16	0.79–1.69	1.39	1.06–1.83	1.77	1.34–2.34
Mood disorder	1.34	0.86–2.08	0.85	0.61–1.16	1.01	0.74–1.38

^a People without history of SMI in each time period were used as the reference group, models adjusted for age, cancer topography and morphology, stage at presentation, cancer treatment and comorbidities.