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Impact of comorbidity on mortality: a cohort study of 62,591 Danish women diagnosed with early breast cancer, 1990–2008

  • Epidemiology
  • Published:
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Abstract

The incidence of breast cancer, as well as other chronic disease, increases with age, older breast cancer patients being more likely than younger to suffer from other diseases at time of diagnosis. Our objective was to assess the effect of comorbidity on mortality after early breast cancer. 62,591 women diagnosed with early breast cancer 1990–2008 were identified using the Danish Breast Cancer Cooperative Group Registry. Data were linked to the Danish National Patient Register and the Danish Register of Causes of Death. Main outcome measures were mortality from all causes, breast cancer, and non-breast cancer causes in relation to Charlson comorbidity index (CCI). Compared with patients without comorbidity (CCI 0), the presence of comorbidity increased the risk of dying from breast cancer as well as other causes with adjusted hazard ratios (HRs) for all-cause mortality of 1.45 (CI 95% 1.40–1.51) for CCI 1, 1.52 (95% CI 1.45–1.60) for CCI 2, and 2.21 (95% CI 2.08–2.35) for CCI 3+. Equivalent HRs for breast cancer-specific mortality were 1.30 (95% CI, 1.24–1.36) for CCI 1, 1.31 (95% CI 1.23–1.39) for CCI 2, and 1.79 (95% CI, 1.66–1.93) for CCI 3+ (all P values < 0.0001). For patients with CCI 0, 5-year overall survival increased over time from 72.5% (95% CI, 71.7–73.3%) in 1990–1994 to 81.6% (95% CI, 80.9–82.2) in 2000–2004, whereas the 5-year overall survival remained stable around 43% among the patients with CCI 3+. This population-based cohort study shows that compared with patients without comorbidity, the risk of dying from breast cancer as well as other causes increased significantly with increasing CCI score. While survival improved over time for patients without comorbidity, no improvement was seen among patients with severe comorbidity (CCI 3+).

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Abbreviations

HR:

Hazard ratio

CI:

Confidence interval

CCI:

The Charlson comorbidity index

DBCG:

The Danish Breast Cancer Cooperative Group

RCD:

The Danish Registers of Causes of Death

CPR:

The Central Population Registry

ER:

Estrogen receptor

CT:

Chemotherapy

E:

Endocrine therapy

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Acknowledgments

The present study was supported by a grant from the Danish Cancer Society.

Conflicts of interest

None.

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Authors and Affiliations

  1. Department of Oncology, Odense University Hospital, Sdr. Boulevard 29, 5000, Odense C, Denmark

    Lotte Holm Land & Marianne Ewertz

  2. Institute of Clinical Research, University of Southern Denmark, Winsløwparken 19, 3, 5000, Odense C, Denmark

    Lotte Holm Land & Marianne Ewertz

  3. Institute of Cancer Epidemiology, The Danish Cancer Society, Strandboulevarden 49, 2100, Copenhagen Ø, Denmark

    Susanne Oksbjerg Dalton

  4. The Danish Breast Cancer Cooperative Group, Rigshospitalet 2501, Blegdamsvej 9, 2100, Copenhagen Ø, Denmark

    Maj-Britt Jensen

Authors
  1. Lotte Holm Land
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  2. Susanne Oksbjerg Dalton
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  3. Maj-Britt Jensen
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  4. Marianne Ewertz
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Correspondence to Lotte Holm Land.

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Land, L.H., Dalton, S.O., Jensen, MB. et al. Impact of comorbidity on mortality: a cohort study of 62,591 Danish women diagnosed with early breast cancer, 1990–2008. Breast Cancer Res Treat 131, 1013–1020 (2012). https://doi.org/10.1007/s10549-011-1819-1

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  • DOI: https://doi.org/10.1007/s10549-011-1819-1

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