Factors associated with suicide/self-inflicted injuries among women aged 18-65 years in the United States: A 13-year retrospective analysis of the National Inpatient Sample database

BACKGROUND

Suicide is a significant cause of mortality in the United States, accounting for 14.5 deaths/100,000. Although there are data on gender disparity in suicide/self-inflicted injury rates in the United States, few studies have examined the factors associated with suicide/self-inflicted injury in females.

OBJECTIVE

To determine factors associated with suicide/self-inflicted injuries among women aged 18-65 years in the United States.

METHODS

Hospitalizations for suicide or self-inflicted injuries were identified using the National Inpatient Sample database from 2003-2015 using sample weights to generate national estimates. Independent predictors of suicide/self-inflicted injuries were identified using multivariable regression models. Interaction term analysis to identify the interaction between race/ethnicity and income were conducted.

RESULTS

There were 1,031,693 adult women hospitalizations in the U.S. with a primary diagnosis of suicide/self-inflicted injury in the study period. The highest suicide/self-inflicted injury risk was among women aged 31-45years (OR = 1.23, CI = 1.19-1.27, p < 0.05). Blacks in the highest income strata had a 20% increase in the odds of suicide/self-inflicted injury compared to Whites in the lowest socioeconomic strata (OR = 1.20, CI = 1.05-1.37, p <0.05). Intimate partner violence increased suicide/self-inflicted injury risk 6-fold (OR = 5.77, CI = 5.01-6.65, p < 0.05).

CONCLUSION

Suicide risk is among women aged 31-45 years, higher earning Black women, intimate partner violence victims, uninsured, and current smokers. Interventions and policies that reduce smoking, prevents intimate partner violence, addresses racial discrimination and bias, and provides universal health coverage are needed to prevent excess mortality from suicide deaths.

Second Malignancies Following Primary Cervical Cancer Diagnosis: Analysis of the SEER Database

Introduction While mortality following primary cervical cancers (PCCs) continues to decline due to advancements in screening and treatment, a small subset of women who developed PCCs will develop second malignancies after their initial diagnosis. Little is known about these women. Objective This study aims to determine the common second malignancies among patients with primary cervical cancers and the factors associated with improved overall survival. Methodology We conducted a retrospective analysis of all PCCs in the SEER database between 1975 and 2016. We identified a subset of patients who subsequently developed secondary malignancies after a primary cervical cancer diagnosis. We then determined the factors associated with a prolonged latency interval, defined as the time between the PCC diagnosis and a subsequent secondary malignancy diagnosis. In a sub-analysis, we also determined the commonest secondary malignancies following a PCC diagnosis. Results A total of 1,494 patients with cervical cancers developed a second malignancy during the study period. The mean age at diagnosis of the PCCs was 56.0 ± 14.0 years. The mean latency interval between PCC and a subsequent secondary malignancy was 9.6 ± 9.3 years. Cytoreductive surgery (odds ratio (OR) = 1.40; 95% confidence interval (CI) = 1.05-1.86) and radiotherapy (OR = 1.52; 95% CI = 1.14-2.03) during the PCC are associated with a prolonged latency interval. Patients who received chemotherapy (OR = 0.23; 95% CI = 0.16-0.33) or those of Hispanic ethnicity (OR = 0.63; 95% CI = 0.44-0.90) were more likely to develop second malignancies within 10 years after a PCC diagnosis. The most common second malignancies were abdominal malignancies with rectal cancers (12.2%), pancreatic cancers (10.1%), stomach cancers (9.2%), cecum cancers (8.4%), and sigmoid colon cancers (8.3%). Conclusion There is a significant association between Hispanic ethnicity and a shorter latency interval among patients with PCC. The findings from this study may help optimize screening for secondary cancers among cervical cancer survivors.

Profile and outcomes of patients with subsequent ovarian cancer diagnosis following a prior malignancy in the United States

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Background: The relationship between a subsequent ovarian cancer and a prior malignancy is complex with possible etiological, genetic, and therapeutic implications. Little is known about the epidemiological and clinical profile of this category of patients. The aim of the present study is to determine the factors associated with the development of ovarian cancer as a subsequent malignancy after a prior malignancy from another organ and determinants of improved survival in these women. Methods: We utilized the SEER 18 Registry 1975-2016 to conduct a retrospective analysis of women who developed a second primary ovarian malignancy following a prior cancer diagnosis. The outcome of interest was the latency interval between the initial primary malignancy diagnosis and a subsequent ovarian cancer diagnosis. Utilizing the cox regression model, we determined the factors associated with the overall survival of these women. Results: There were 10, 800 women who subsequently developed ovarian cancers following a prior malignancy. The commonest prior malignancies were breast cancers (38.2%), endometrial cancers (23.7%), and colorectal cancers (9.5%). The latency interval from developing a subsequent ovarian malignancy was 6.8±6.3 yrs. (Breast cancers) and 0.6 ± 2.5 yrs. (Endometrial cancers). A prior surgical treatment (OR = 1.19; 95% CI 1.02-1.40) or radiotherapy (OR = 1.34, 95% CI 1.21-1.49) in the initial primary malignancy is associated with a > 5years development of a subsequent ovarian malignancy. Black patients (OR = 1.63, 95% CI 1.39-1.92) have the worst survival even after controlling for disease stage and treatment modalities. Determinants of improved overall survival include White race, private insurance, age < 45 years at first primary malignancy diagnosis, prior surgical therapy, and increased latency interval. A prolonged latency interval is associated with a 74% increase in survival (OR = 0.26; 95%CI 0.23-0.30). Conclusions: Determinants of improved survival among patients with subsequent ovarian cancers following a prior primary malignancy include White race, private insurance, and a prolonged latency interval of progression from an initial primary malignancy to a subsequent ovarian cancer.