Association between cumulative exposure periods of flupentixol or any antipsychotics and risk of lung cancer.

BACKGROUND: Preclinical evidence suggests that certain antipsychotic medications may inhibit the development of lung cancer. This study aims to investigate the association between incident lung cancer and different cumulative exposure periods of flupentixol or any antipsychotics. METHODS: Using electronic health records from the Hospital Authority in Hong Kong, this nested case-control study included case participants aged 18 years or older with newly diagnosed lung cancer after initiating antipsychotics between January 1, 2003, and August 31, 2022. Each case was matched to up to ten controls of the same sex and age, who were also antipsychotic users. Multivariable conditional logistic regression models were conducted to quantify the association between lung cancer and different cumulative exposure times of flupentixol (0-365 days [ref]; 366-1825 days; 1826+ days) and any antipsychotics (1-365 days [ref]; 366-1825 days; 1826+ days), separately. RESULTS: Here we show that among 6435 cases and 64,348 matched controls, 64.06% are males, and 52.98% are aged 65-84 years. Compared to patients with less than 365 days of exposure, those with 366-1825 days of exposure to flupentixol (OR = 0.65 [95% CI, 0.47-0.91]) and any antipsychotics (0.42 [0.38-0.45]) have a lower risk of lung cancer. A decreased risk is observed in patients who have 1826+ days of cumulative use of any antipsychotics (0.54 [0.47-0.60]). CONCLUSIONS: A reduced risk of lung cancer is observed in patients with more than one year of exposure to flupentixol or any antipsychotics. Further research on the association between lung cancer and other antipsychotic agents is warranted.

Antipsychotic drugs are mainly used to treat mental illnesses. Certain antipsychotic medications, such as flupentixol, may help protect patients against lung cancer. Here, we investigated whether prolonged use of flupentixol or other antipsychotics could reduce the occurrence of lung cancer among antipsychotic users. We demonstrated that a smaller proportion of patients with one to five years and more than five years of exposure to any antipsychotics develop lung cancer compared to those with less than one year of exposure. Specifically, for flupentixol, we observed a smaller proportion of patients with one to five years of exposure develop lung cancer compared to those with less than one year. To substantiate our current findings, further studies examining other populations and specific antipsychotic agents are necessary for developing effective lung cancer prevention strategies among this high-risk population.

Breast cancer risks following antipsychotic use in women with bipolar disorder versus schizophrenia: A territory-wide nested case-control study spanning two decades.

Accrued epidemiologic data largely support an association of antipsychotic use with breast cancer in women with schizophrenia. No studies have specifically investigated such risks in women with bipolar disorder. This study aims to examine the association between antipsychotics and breast cancer in women with bipolar disorder and compare it against schizophrenia. We conducted a nested case-control study using a territory-wide public healthcare database in Hong Kong examining women aged ≥18 years with bipolar disorder or schizophrenia. Using incidence density sampling, women with a breast cancer diagnosis were matched by up to 10 control participants. In total, 672 case participants (109 with bipolar disorder) and 6,450 control participants (931 with bipolar disorder) were included. Results show a significant association of first-generation antipsychotics with breast cancer in both women with schizophrenia [adjusted odds ratio (aOR) 1.49, 95% confidence interval (CI) 1.17-1.90] or bipolar disorder (aOR 1.80, 95% CI 1.11-2.93). Second-generation antipsychotics was associated with breast cancer only in women with bipolar disorder (aOR 2.49, 95% CI 1.29-4.79), with no significant association found in women with schizophrenia (aOR 1.10, 95% CI 0.88-1.36). In conclusion, further research on breast cancer risks is warranted for women with bipolar disorder on antipsychotics.

A global scale COVID-19 variants time-series analysis across 48 countries.

Background: The coronavirus disease (COVID-19) pandemic is slowing down, and countries are discussing whether preventive measures have remained effective or not. This study aimed to investigate a particular property of the trend of COVID-19 that existed and if its variants of concern were cointegrated, determining its possible transformation into an endemic. Methods: Biweekly expected new cases by variants of COVID-19 for 48 countries from 02 May 2020 to 29 August 2022 were acquired from the GISAID database. While the case series was tested for homoscedasticity with the Breusch-Pagan test, seasonal decomposition was used to obtain a trend component of the biweekly global new case series. The percentage change of trend was then tested for zero-mean symmetry with the one-sample Wilcoxon signed rank test and zero-mean stationarity with the augmented Dickey-Fuller test to confirm a random COVID trend globally. Vector error correction models with the same seasonal adjustment were regressed to obtain a variant-cointegrated series for each country. They were tested by the augmented Dickey-Fuller test for stationarity to confirm a constant long-term stochastic intervariant interaction within the country. Results: The trend series of seasonality-adjusted global COVID-19 new cases was found to be heteroscedastic (p = 0.002), while its rate of change was indeterministic (p = 0.052) and stationary (p = 0.024). Seasonal cointegration relationships between expected new case series by variants were found in 37 out of 48 countries (p < 0.05), reflecting a constant long-term stochastic trend in new case numbers contributed from different variants of concern within most countries. Conclusion: Our results indicated that the new case long-term trends were random on a global scale and stable within most countries; therefore, the virus was unlikely to be eliminated but containable. Policymakers are currently in the process of adapting to the transformation of the pandemic into an endemic.

Barriers and Determinants to the Underutilized Hypertension Screening in Primary Care Patients in Hong Kong: A Mixed-Method Study.

(1) Background: Hypertension (HT) is the most common chronic condition, affecting approximately 1.13 billion people worldwide. Despite freely available blood pressure (BP) devices in primary care (PC) clinics, many patients do not regularly screen for HT and are untreated. (2) Methods: This study investigated the proportion of PC patients who did not screen for HT and the underlying reasons in Hong Kong. An explanatory mixed-method cross-sectional study was conducted in 2020, which included a questionnaire survey, office BP measurements, and subsequent semi-structured interviews. Adult patients who had no diagnosis of HT were recruited in a large PC clinic by convenience sampling. The relationships between not having HT screening and sociodemographic data were investigated by logistic regression. Twenty-four patients were purposefully sampled (based on demographics) and were interviewed until data saturation. (3) Results: Among 428 participants, 190 (44.4%) had not had HT screening in the last two years, but 197 (46.0%) had HT. No HT screening in the last two years or ever was associated with being male, being single, being of younger age, having no family history of HT, having no clinic visits in the last two years, employment status, and self-perceived HT condition. Most participants (77.8%) misinterpreted their BP readings. Individual, social, and healthcare service barriers were identified in patients' interviews. Many PC patients had no regular HT screening but around half had elevated BP. (4) Conclusion: The study results indicate that the barriers to HT screening were multifactorial. HT screening in PC is urgently needed.

Association of antipsychotic use with breast cancer: a systematic review and meta-analysis of observational studies with over 2 million individuals.

AIMS: Despite reports of an elevated risk of breast cancer associated with antipsychotic use in women, existing evidence remains inconclusive. We aimed to examine existing observational data in the literature and determine this hypothesised association. METHODS: We searched Embase, PubMed and Web of Science™ databases on 27 January 2022 for articles reporting relevant cohort or case-control studies published since inception, supplemented with hand searches of the reference lists of the included articles. Quality of studies was assessed using the Newcastle-Ottawa Scale. We generated the pooled odds ratio (OR) and pooled hazard ratio (HR) using a random-effects model to quantify the association. This study was registered with PROSPERO (CRD42022307913). RESULTS: Nine observational studies, including five cohort and four case-control studies, were eventually included for review (N = 2 031 380) and seven for meta-analysis (N = 1 557 013). All included studies were rated as high-quality (seven to nine stars). Six studies reported a significant association of antipsychotic use with breast cancer, and a stronger association was reported when a greater extent of antipsychotic use, e.g. longer duration, was operationalised as the exposure. Pooled estimates of HRs extracted from cohort studies and ORs from case-control studies were 1.39 [95% confidence interval (CI) 1.11-1.73] and 1.37 (95% CI 0.90-2.09), suggesting a moderate association of antipsychotic use with breast cancer. CONCLUSIONS: Antipsychotic use is moderately associated with breast cancer, possibly mediated by prolactin-elevating properties of certain medications. This risk should be weighed against the potential treatment effects for a balanced prescription decision.