Cardiovascular Diseases And Psychiatric Disorders During The Diagnostic Workup Of Suspected Hematological Malignancy

Figures & data

Table 1 Characteristics Of Patients With Hematological Malignancy And Individuals That Underwent A Bone Marrow Or Lymph Node Biopsy, A Population-Based Cohort Study During 2005–2014 In Skåne, Sweden

Characteristics	Patients With Hematological Malignancy^a	Biopsied Individuals^b
No. of patients or individuals	5495	18,906
Male (%)	3007 (54.7%)	8673 (45.9%)
Median age at diagnosis or biopsy, years	70	56
Civil status
- Cohabitating	2917 (53.1%)	8394 (44.4%)
- Non-cohabitating	2578 (46.9%)	10,512 (55.6%)
Preexisting cardiovascular diseases at diagnosis or biopsy
- Yes	2749 (50.0%)	7062 (37.4%)
- No	2746 (50.0%)	11,844 (62.6%)
Preexisting psychiatric disorders at diagnosis or biopsy
- Yes	961 (17.5%)	5570 (29.5%)
- No	4534 (82.5%)	13,336 (70.5%)

Notes: ^aIncluding 784 patients with leukemia (excluding chronic lymphoid leukemia), 322 patients with myelodysplastic syndrome, 474 patients with myeloproliferative neoplasm, 767 patients with myeloma and 3148 patients with lymphoma (including chronic lymphoid leukemia). ^bIncluding 2050 individuals with bone marrow aspiration or biopsy and 16,856 patients with lymph node biopsy.

Table 2 Incidence Rates (Irs, Per 1000 Person-months) And Incidence Rate Ratios (IRRs) Of Cardiovascular Diseases And Psychiatric Disorders During The Diagnostic Workup And Post-Diagnostic Period Of Patients With Hematological Malignancy, A Population-Based Cohort During 2005–2014 In Skåne, Sweden^a

	Diagnostic Workup				Post-Diagnostic Period
	No. Of Diagnoses	Crude IR	IRR (95% CI)^c	No. Of Affected Patients (%)	No. Of Diagnoses	Crude IR	IRR (95% CI)^c	No. Of Affected Patients (%)
Cardiovascular diseases
Reference^b	646,672	4.7	1.0		646,672	4.7	1.0
Patients with any hematological malignancy	305	53.4	3.3 (2.9–3.8)	264 (4.8)	925	32.5	1.9 (1.8–2.1)	642 (12.0)
Leukemia	32	90.3	6.4 (4.4–9.1)	30 (3.8)	122	33.9	2.6 (2.1–3.3)	83 (11.3)
Myelodysplastic syndrome	10	68.3	3.3 (1.7–6.4)	9 (2.8)	62	36.8	1.7 (1.2–2.3)	44 (13.9)
Myeloproliferative neoplasm	23	107.7	5.4 (3.6–8.1)	22 (4.6)	110	41.9	2.0 (1.5–2.6)	68 (14.5)
Myeloma	40	56.9	3.3 (2.3–4.7)	212 (27.6)	122	30.0	1.7 (1.4–2.1)	97 (12.9)
Lymphoma	200	46.6	3.0 (2.6–3.5)	172 (5.5)	509	30.8	1.9 (1.7–2.1)	350 (11.4)
Psychiatric disorders
Reference^b	984,268	7.2	1.0		984,268	7.2	1.0
Patients with any hematological malignancy	59	10.4	2.1 (1.5–2.8)	48 (0.9)	215	7.6	1.4 (1.1–1.7)	114 (2.1)
Leukemia	1	2.8	0.5 (0.1–3.6)	1 (0.1)	29	8.1	1.4 (0.9–2.3)	19 (2.6)
Myelodysplastic syndrome	1	6.8	1.7 (0.3–11.2)	1 (0.3)	4	2.4	0.6 (0.2–1.8)	3 (0.9)
Myeloproliferative neoplasm	1	4.6	0.9 (0.1–6.4)	1 (0.2)	27	10.3	2.0 (1.1–3.4)	12 (2.6)
Myeloma	7	10.0	2.0 (0.8–5.0)	5 (0.7)	24	5.9	1.1 (0.6–1.9)	15 (2.0)
Lymphoma	49	11.4	2.3 (1.6–3.3)	40 (12.7)	131	7.9	1.4 (1.0–1.9)	65 (2.1)

Notes: ^aDiagnostic workup was defined as the time interval starting from 1 week before date of diagnosis until 1 week after diagnosis for patients with leukemia, myelodysplastic syndrome, and myeloproliferative neoplasm, from 3 weeks until 1 week after diagnosis for patients with myeloma, and from 5 weeks before until 1 week after diagnosis for patients with lymphoma. Post-diagnostic period was defined as a 6-month period after the defined diagnostic workup for respective patients. ^bReference included person-time accumulated during the follow-up of individuals that were not identified as patients with hematological malignancy or biopsied individuals as well as person-time accumulated before the defined diagnostic workup from patients with hematological malignancy and biopsied individuals. ^cAdjusted for attained age and calendar year, sex, civil status, preexisting cardiovascular disease or psychiatric disorder, and registered parish.

Abbreviation: CI, confidence interval.

Table 3 Incidence Rates (Irs, Per 1000 Person-months) And Incidence Rate Ratios (IRRs) Of Cardiovascular Diseases And Psychiatric Disorders During The Diagnostic Workup And Post-Diagnostic Period Of Biopsied Individuals, A Population-Based Cohort Study During 2005–2014 In Skåne, Sweden^a

	Diagnostic Workup				Post-Diagnostic Period
	No. Of diagnoses	Crude IR	IRR (95% CI)^c	No. Of Affected Individuals (%)	No. Of Diagnoses	Crude IR	IRR (95% CI)^c	No. Of Affected Individuals (%)
Cardiovascular diseases
Reference^b	646,672	4.7	1.0		646,672	4.7	1.0
All biopsied individuals	1157	48.7	4.9 (4.6–5.3)	1016 (5.4)	2240	21.2	1.9 (1.8–2.0)	1420 (7.6)
Individuals with bone marrow aspiration or biopsy	116	126.3	7.0 (5.8–8.5)	105 (5.1)	511	45.6	2.5 (2.2–2.8)	287 (14.2)
Individuals with lymph node biopsy	1041	45.6	4.8 (4.5–5.1)	911 (5.4)	1729	18.3	1.8 (1.7–1.9)	1133 (6.8)
Psychiatric disorder
Reference^b	984,268	7.2	1.0		984,268	7.2	1.0
All biopsied individuals	748	31.8	3.1 (2.9–3.4)	615 (3.3)	2194	20.8	1.8 (1.7–2.0)	1261 (6.8)
Individuals with bone marrow aspiration or biopsy	6	6.5	1.0 (0.4–2.1)	6 (0.3)	115	10.3	1.4 (1.1–1.9)	58 (2.9)
Individuals with lymph node biopsy	742	32.8	3.2 (2.9–3.5)	609 (3.6)	2079	22.0	1.9 (1.8–2.0)	1203 (7.3)

Notes: ^aDiagnostic workup was defined as the time interval starting from 1 week before the date of biopsy until 1 week after biopsy for patients with bone marrow aspiration or biopsy, and from 5 weeks before until 1 week after biopsy for patients with lymph node biopsy. Post-diagnostic period was defined as a 6-month period after the defined diagnostic workup for respective patients. ^bReference included person-time accumulated during the follow-up of individuals that were not identified as patients with hematological malignancy or biopsied individuals as well as person-time accumulated before the defined diagnostic workup from patients with hematological malignancy and biopsied individuals. ^cAdjusted for attained age and calendar year, sex, civil status, preexisting cardiovascular disease or psychiatric disorder, and registered parish.

Abbreviation: CI, confidence interval.

Table 4 Incidence Rates (Irs, Per 1000 Person-months) And Incidence Rate Ratios (IRRs) Of Cardiovascular Diseases And Psychiatric Disorders During The Diagnostic Workup And Post-Diagnostic Period, Compared To The Reference Period Before The Diagnostic Workup Among Patients With Hematological Malignancy And Biopsied Individuals, A Self-Comparison Analysis^a

	Reference Period			Diagnostic Workup			Post-Diagnostic Period
	No. Of Diagnoses	Crude IR	IRR (95% CI)^b	No. Of Diagnoses	Crude IR	IRR (95% CI)^b	No. Of Diagnoses	Crude IR	IRR (95% CI)^b
Cardiovascular diseases
Patients with hematological malignancy	3885	12.6	1.0	305	53.4	3.0 (2.5–3.6)	925	32.5	1.6 (1.4–1.8)
Biopsied individuals	10,925	9.6	1.0	1157	48.7	3.8 (3.4–4.1)	2240	21.2	1.5 (1.4–1.6)
Psychiatric disorder
Patients with hematological malignancy	1453	4.7	1.0	59	10.4	2.1 (1.4–3.1)	215	7.6	1.5 (1.2–1.9)
Biopsied individuals	12,049	10.7	1.0	748	31.8	2.5 (2.2–2.7)	2194	20.8	1.3 (1.2–1.4)

Notes: ^aDiagnostic workup was defined as the time interval starting from 1 week before date of diagnosis until 1 week after diagnosis for patients with leukemia, myelodysplastic syndrome, and myeloproliferative neoplasm, from 3 weeks before until 1 week after diagnosis for patients with myeloma, and from 5 weeks before until 1 week after diagnosis for patients with lymphoma. Diagnostic workup was defined as the time interval starting from 1 week before the date of biopsy until 1 week after biopsy for biopsied individuals with a bone marrow aspiration or biopsy, and from 5 weeks before until 1 week after biopsy for biopsied individuals with a lymph node biopsy. Post-diagnostic period was defined as a 6-month period after the defined diagnostic workup for respective patients. Reference period was defined as the time interval starting from cohort entry until the start of diagnostic workup. ^bAdjusted for attained age and calendar year, civil status, preexisting cardiovascular disease or psychiatric disorder, and registered parish.

Abbreviations: CI, confidence interval.

Figure 1 Incidence rate ratios (IRRs) and their 95% confidence intervals (CIs) of cardiovascular diseases and psychiatric disorders during the diagnostic workup of patients with hematological malignancy or biopsied individuals, separating the analyses by before or after date of diagnosis or biopsy.