title: Analyzing excess mortality from cancer among individuals with mental illness.
abstract: BACKGROUND
  The objective was to compare patterns of site-specific cancer mortality in a population of individuals with and without mental illness.
  
  
  METHODS
  This was a cross-sectional, population-based study using a linked data set comprised of death certificate data for the state of Ohio for the years 2004-2007 and data from the publicly funded mental health system in Ohio. Decedents with mental illness were those identified concomitantly in both data sets. We used age-adjusted standardized mortality ratios (SMRs) in race- and sex-specific person-year strata to estimate excess deaths for each of the anatomic cancer sites.
  
  
  RESULTS
  Overall, there was excess mortality from cancer associated with having mental illness in all the race/sex strata: SMR, 2.16 (95% CI, 1.85-2.50) for black men; 2.63 (2.31-2.98) for black women; 3.89 (3.61-4.19) for nonblack men; and 3.34 (3.13-3.57) for nonblack women. In all the race/sex strata except for black women, the highest SMR was observed for laryngeal cancer, 3.94 (1.45-8.75) in black men and 6.51 (3.86-10.35) and 6.87 (3.01-13.60) in nonblack men and women, respectively. The next highest SMRs were noted for hepatobiliary cancer and cancer of the urinary tract in all race/sex strata, except for black men.
  
  
  CONCLUSIONS
  Compared with the general population in Ohio, individuals with mental illness experienced excess mortality from most cancers, possibly explained by a higher prevalence of smoking, substance abuse, and chronic hepatitis B or C infections in individuals with mental illness. Excess mortality could also reflect late-stage diagnosis and receipt of inadequate treatment.
authors.affiliation: Department of Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA.
authors.forename: Jackson S
authors.initials: JS
authors.lastname: Musuuza
authors.forename: Marion E
authors.initials: ME
authors.lastname: Sherman
authors.forename: Kraig J
authors.initials: KJ
authors.lastname: Knudsen
authors.forename: Helen Anne
authors.initials: HA
authors.lastname: Sweeney
authors.forename: Carl V
authors.initials: CV
authors.lastname: Tyler
authors.forename: Siran M
authors.initials: SM
authors.lastname: Koroukian
mesh_terms: D000293:Adolescent; D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data; D000368:Aged; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005260:Female; D006521:Hepatitis, Chronic / Q000175:diagnosis / Q000628:therapy; D006801:Humans; D007223:Infant; D008297:Male; D008403:Mass Screening; D001523:Mental Disorders / Q000150:complications / Q000453:epidemiology*; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications / Q000209:etiology / Q000401:mortality*; D009820:Ohio / Q000453:epidemiology; D012307:Risk Factors; D016540:Smoking Cessation; D019966:Substance-Related Disorders / Q000517:prevention & control / Q000628:therapy