Incidence and Risk of Suicide Among Patients With Head and Neck Cancer in Rural, Urban, and Metropolitan Areas
| Autor: | Nosayaba Osazuwa-Peters, Eric Adjei Boakye, Matthew C. Simpson, Somtochi I Okafor, Walter T. Lee, Evan M. Graboyes, Derian B Taylor, Justin M. Barnes, Adnan S. Hussaini |
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| Rok vydání: | 2021 |
| Předmět: |
Adult
Male medicine.medical_specialty Adolescent Population Rural Health Lower risk Risk Assessment Suicide prevention Young Adult Residence Characteristics Risk Factors Epidemiology Humans Medicine education Aged Proportional Hazards Models Retrospective Studies Original Investigation education.field_of_study business.industry Incidence Rural health Mortality rate Urban Health Middle Aged Metropolitan area United States Suicide Cross-Sectional Studies Otorhinolaryngology Head and Neck Neoplasms Female Surgery Rural area business SEER Program Demography |
| Zdroj: | JAMA Otolaryngol Head Neck Surg |
| ISSN: | 2168-6181 |
| DOI: | 10.1001/jamaoto.2021.1728 |
| Popis: | Importance Patients with head and neck cancer (HNC) are known to be at increased risk of suicide compared with the general population, but there has been insufficient research on whether this risk differs based on patients’ rural, urban, or metropolitan residence status. Objective To evaluate whether the risk of suicide among patients with HNC differs by rural vs urban or metropolitan residence status. Design, Setting, and Participants This cross-sectional study uses data from the Surveillance, Epidemiology, and End Results database on patients aged 18 to 74 years who received a diagnosis of HNC from January 1, 2000, to December 31, 2016. Statistical analysis was conducted from November 27, 2020, to June 3, 2021. Exposures Residence status, assessed using 2013 Rural Urban Continuum Codes. Main Outcomes and Measures Death due to suicide was assessed byInternational Statistical Classification of Diseases and Related Health Problems, Tenth Revisioncodes (U03, X60-X84, and Y87.0) and the cause of death recode (50220). Standardized mortality ratios (SMRs) of suicide, assessing the suicide risk among patients with HNC compared with the general population, were calculated. Suicide risk by residence status was compared using Fine-Gray proportional hazards regression models. Results Data from 134 510 patients with HNC (101 142 men [75.2%]; mean [SE] age, 57.7 [10.3] years) were analyzed, and 405 suicides were identified. Metropolitan residents composed 86.6% of the sample, urban residents composed 11.7%, and rural residents composed 1.7%. The mortality rate of suicide was 59.2 per 100 000 person-years in metropolitan counties, 64.0 per 100 000 person-years in urban counties, and 126.7 per 100 000 person-years in rural counties. Compared with the general population, the risk of suicide was markedly higher among patients with HNC in metropolitan (SMR, 2.78; 95% CI, 2.49-3.09), urban (SMR, 2.84; 95% CI, 2.13-3.71), and rural (SMR, 5.47; 95% CI, 3.06-9.02) areas. In Fine-Gray competing-risk analyses that adjusted for other covariates, there was no meaningful difference in suicide risk among urban vs metropolitan residents. However, compared with rural residents, residents of urban (subdistribution hazard ratio, 0.52; 95% CI, 0.29-0.94) and metropolitan counties (subdistribution hazard ratio, 0.55; 95% CI, 0.32-0.94) had greatly lower risk of suicide. Conclusions and Relevance The findings of this cross-sectional study suggest that suicide risk is elevated in general among patients with HNC but is significantly higher for patients residing in rural areas. Effective suicide prevention strategies in the population of patients with HNC need to account for rural health owing to the high risk of suicide among residents with HNC in rural areas. |
| Databáze: | OpenAIRE |
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