肺癌患者自杀危险因素的巢式病例对照研究

A nested case-control study of suicide risk factors in patients with lung cancer

目的:识别肺癌患者中的自杀高危人群,分析自杀相关的影响因素。方法:收集美国SEER数据库中1975-2016年确诊的肺癌患者,计算患者自杀率和标化死亡比(SMR);采用巢式病例对照研究设计,纳入934例肺癌自杀患者作为病例组,按照1∶20的配比匹配同性别、同年龄的18669例非自杀患者作为对照组,通过构建条件logistic回归模型,评估肺癌患者自杀相关危险因素。结果:肺癌患者的自杀率高于一般人群(SMR=12.00),女性、青年、确诊后1年内、肿瘤细胞未分化、远端转移和无配偶的肺癌患者SMR较高(SMR=26.55、54.10、26.68、20.04、29.67、50.90、17.71);条件logistic回归分析显示,确诊后1年内、肿瘤细胞未分化、拒绝手术、未化疗和无配偶的肺癌患者易发生自杀行为(OR=23.53、1.88、1.31、1.57、1.53)。结论:肺癌患者的自杀风险明显高于一般人群,确诊后1年内、肿瘤细胞未分化、拒绝手术、未化疗和无配偶可能是肺癌患者自杀的危险因素。

Objective:To identify the high-risk groups of suicide among lung cancer patients and analyze the related factors for suicide.Methods:The patients with lung cancer diagnosed from 1975 to 2016 in the US SEER database(SEER) were collected, and the suicide rate and Standard Mortality Ratio(SMR) were calculated by using nested case control study.The study design included 934 suicide patients with lung cancer as the case group, and matched 18 669 non-suicide patients of the same sex and the same age as the control group according to a 1∶20 ratio.By constructing a conditional logistic regression model, the risk factors for suicide in patients with lung cancer were assessed.Results:The suicide rate of was higher in patients with lung cancer than in the general population(SMR=12.00).The SMR was higher in patients who were females, youth, within one year after diagnosis, undifferentiated tumor cells, distant metastasis and no spouse(SMR=26.55,54.10,26.68,20.04,29.67,50.90,17.71).Conditional logistic regression analysis showed that patients with lung cancer within one year after diagnosis, with undifferentiated tumor cells, refused surgery, without chemotherapy and without spouse were prone to suicidal behaviors(OR=23.53,1.88,1.31,1.57,1.53).Conclusion:The suicide risk of patients with lung cancer is higher than that of the general population.Within 1 year after diagnosis, undifferentiated tumor cells, refusal of surgery, no chemotherapy and no spouse may be the risk factors of suicide in patients with lung cancer.