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Inequalities in lung cancer care of elderly patients with schizophrenia: an observational cohort study.
- Source :
-
Psychosomatic medicine [Psychosom Med] 2014 Apr; Vol. 76 (3), pp. 215-20. - Publication Year :
- 2014
-
Abstract
- Objective: Cancer mortality is higher in individuals with schizophrenia, a finding that may be due, in part, to inequalities in care. We evaluated gaps in lung cancer diagnosis, treatment, and survival among elderly individuals with schizophrenia.<br />Methods: The Surveillance, Epidemiology, and End Results database linked to Medicare records was used to identify patients 66 years or older with primary non-small cell lung cancer. Lung cancer stage, diagnostic evaluation, and rates of stage-appropriate treatment were compared among patients with and without schizophrenia using unadjusted and multiple regression analyses. Survival was compared among groups using Kaplan-Meier methods.<br />Results: Of the 96,702 patients with non-small cell lung cancer in the Surveillance, Epidemiology, and End Results database, 1303 (1.3%) had schizophrenia. In comparison with the general population, patients with schizophrenia were less likely to present with late-stage disease after controlling for age, sex, marital status, race/ethnicity, income, histology, and comorbidities (odds ratio = 0.82, 95% confidence interval = 0.73-0.93) and were less likely to undergo appropriate evaluation (p < .050 for all comparisons). Adjusting for similar factors, patients with schizophrenia were also less likely to receive stage-appropriate treatment (odds ratio = 0.50, 95% confidence interval = 0.43-0.58). Survival was decreased among patients with schizophrenia (mean survival = 22.3 versus 26.3 months, p = .002); however, no differences were observed after controlling for treatment received (p = .40).<br />Conclusions: Elderly patients with schizophrenia present with earlier stages of lung cancer but are less likely to undergo diagnostic evaluation or to receive stage-appropriate treatment, resulting in poorer outcomes. Efforts to increase treatment rates for elderly patients with schizophrenia may lead to improved survival in this group.
- Subjects :
- Age Factors
Aged
Carcinoma, Non-Small-Cell Lung diagnosis
Carcinoma, Non-Small-Cell Lung therapy
Cohort Studies
Comorbidity
Female
Humans
Kaplan-Meier Estimate
Lung Neoplasms diagnosis
Lung Neoplasms therapy
Male
Medicare statistics & numerical data
Regression Analysis
Severity of Illness Index
Survival Rate
United States epidemiology
Carcinoma, Non-Small-Cell Lung mortality
Healthcare Disparities statistics & numerical data
Lung Neoplasms mortality
Primary Health Care statistics & numerical data
SEER Program
Schizophrenia mortality
Subjects
Details
- Language :
- English
- ISSN :
- 1534-7796
- Volume :
- 76
- Issue :
- 3
- Database :
- MEDLINE
- Journal :
- Psychosomatic medicine
- Publication Type :
- Academic Journal
- Accession number :
- 24677164
- Full Text :
- https://doi.org/10.1097/PSY.0000000000000050