title: Differences in cancer stage, treatment and in-hospital mortality between patients with and without schizophrenia: retrospective matched-pair cohort study.
abstract: BACKGROUND
  Healthcare access and outcomes in cancer patients with schizophrenia remain unclear.
  
  
  OBJECTIVE
  To investigate the likelihood of early diagnosis and treatment in patients with schizophrenia who have cancer and their prognosis.
  
  
  METHODS
  A retrospective matched-pair cohort of gastrointestinal cancer patients was identified using a national in-patient database in Japan. Multivariable ordinal/binary logistic regressions was modelled to compare cancer stage at admission, invasive treatments and 30-day in-hospital mortality between patients with schizophrenia (n = 2495) and those without psychiatric disorders (n = 9980).
  
  
  RESULTS
  The case group had a higher proportion of stage IV cancer (33.9% v. 18.1%), a lower proportion of invasive treatment (56.5% v. 70.2%, odds ratio (OR) = 0.77, 95% CI 0.69-0.85) and higher in-hospital mortality (4.2% v. 1.8%, OR = 1.35, 95% CI 1.04-1.75).
  
  
  CONCLUSIONS
  Patients with schizophrenia who had gastrointestinal cancer had more advanced cancer, a lower likelihood of invasive treatment and higher in-hospital mortality than those without psychiatric disorders.
authors.affiliation: Hanako Ishikawa, MD, MPH, Department of Mental Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan; Hideo Yasunaga, MD, PhD, Hiroki Matsui, MPH, Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan; Kiyohide Fushimi, MD, PhD, Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School of Medicine, Tokyo, Japan; Norito Kawakami, MD, PhD, Department of Mental Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
authors.forename: Hanako
authors.initials: H
authors.lastname: Ishikawa
authors.affiliation: Hanako Ishikawa, MD, MPH, Department of Mental Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan; Hideo Yasunaga, MD, PhD, Hiroki Matsui, MPH, Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan; Kiyohide Fushimi, MD, PhD, Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School of Medicine, Tokyo, Japan; Norito Kawakami, MD, PhD, Department of Mental Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan yasunagah-tky@umin.ac.jp.
authors.forename: Hideo
authors.initials: H
authors.lastname: Yasunaga
authors.affiliation: Hanako Ishikawa, MD, MPH, Department of Mental Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan; Hideo Yasunaga, MD, PhD, Hiroki Matsui, MPH, Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan; Kiyohide Fushimi, MD, PhD, Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School of Medicine, Tokyo, Japan; Norito Kawakami, MD, PhD, Department of Mental Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
authors.forename: Hiroki
authors.initials: H
authors.lastname: Matsui
authors.affiliation: Hanako Ishikawa, MD, MPH, Department of Mental Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan; Hideo Yasunaga, MD, PhD, Hiroki Matsui, MPH, Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan; Kiyohide Fushimi, MD, PhD, Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School of Medicine, Tokyo, Japan; Norito Kawakami, MD, PhD, Department of Mental Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
authors.forename: Kiyohide
authors.initials: K
authors.lastname: Fushimi
authors.affiliation: Hanako Ishikawa, MD, MPH, Department of Mental Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan; Hideo Yasunaga, MD, PhD, Hiroki Matsui, MPH, Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan; Kiyohide Fushimi, MD, PhD, Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School of Medicine, Tokyo, Japan; Norito Kawakami, MD, PhD, Department of Mental Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
authors.forename: Norito
authors.initials: N
authors.lastname: Kawakami
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016208:Databases, Factual; D004724:Endoscopy; D005260:Female; D005770:Gastrointestinal Neoplasms / Q000150:complications* / Q000401:mortality* / Q000601:surgery; D017052:Hospital Mortality; D006801:Humans; D007564:Japan; D007902:Length of Stay; D008017:Life Expectancy; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D016017:Odds Ratio; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D012559:Schizophrenia / Q000175:diagnosis*; D012720:Severity of Illness Index