Depression Is Associated with a Higher Risk of Mortality among Breast Cancer Survivors: Results from the National Health and Nutrition Examination Survey–National Death Index Linked Study
Abstract
:1. Introduction
2. Methods
2.1. Study Sample and Measures
2.2. Statistical Analysis
3. Results
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Characteristics | Total Population (n = 4719) | Breast Cancer (+) (n = 240) | Breast Cancer (−) (n = 4479) | Depression + (n = 479) | Depression − (n = 2526) |
---|---|---|---|---|---|
Age (Mean, years) | 60.8 (60.2–61.3) | 66.3 (64.1–68.5) ** | 60.5 (59.9–61.0) | 57.0 (55.7–58.2) | 60.7 (60.0–61.3) * |
Age Group (%, 95% CI) | |||||
45–54 Years | 38.0 (35.8–40.1) | 17.4 (12.3–22.6) | 38.8 (36.6–41.1) ** | 51.2 (44.3–58.1) ** | 37.7 (35.1–40.2) |
55–64 Years | 26.6 (24.9–28.5) | 20.8 (15.1–26.6) | 26.8 (25.1–28.5) | 30.0 (24.3–35.7) | 26.4 (24.3–28.5) |
≥65 Years | 35.5 (33.0–38.0) | 61.7 (54.3–69.2) | 34.3 (31.8–36.9) | 18.8 (14.0–23.7) | 35.9 (33.2–38.6) |
Family Poverty-Income-Ratio (PIR < 1) | 10.6 (9.3–11.9) | 9.6 (6.0–14.9) | 10.7 (9.3–12.0) | 37.9 (31.1–44.7) ** | 21.2 (19.0–23.5) |
No Health Insurance (%, 95% CI) | 11.2 (9.6–12.9) | 4.1 (1.9–8.8) | 11.6 (9.9–13.4) ** | 23.2 (18.8–27.6) ** | 16.8 (14.8–18.8) |
Education Level (%, 95% CI) | |||||
Some High School | 20.1 (18.2–22.12) | 15.9 (10.0–21.8) | 20.4 (18.3–22.4) * | 42.3 (37.1–47.6) ** | 32.4 (29.2–35.5) |
High School Graduate | 25.3 (23.5–27.1) | 23.1 (15.8–30.4) | 25.4 (23.7–27.1) | 23.0 (18.1–27.9) | 25.1 (22.5–27.6) |
Some College and Beyond | 54.6 (51.6–57.6) | 61.0 (52.2–69.8) | 54.2 (51.3–57.1) | 34.7 (29.0–40.3) | 42.6 (39.7–45.4) |
Race/Ethnicity (%, 95% CI) | |||||
Non-Hispanic White | 75.4 (71.8–79.1) | 85.9 (81.5–90.3) ** | 74.6 (71.1–78.6) | 36.5 (29.1–43.9) | 44.8 (38.0–51.5) ** |
Non-Hispanic Black | 11.0 (8.8–13.1) | 8.2 (5.8–11.5) | 11.1 (9.0–13.3) | 30.3 (23.4–37.1) | 29.8 (24.9–34.7) |
Hispanic | 8.3 (6.5–10.5) | 3.0 (1.9–4.9) | 8.6 (6.7–10.8) | 30.5 (21.8–39.1) | 22.4 (17.6–27.2) |
Other | 5.3 (4.3–6.6) | 2.9 (1.0–7.7) | 5.4 (4.4–6.8) | 2.8 (1.3–5.8) | 3.0 (2.1–4.4) |
Marital Status (%, 95% CI)*/** | |||||
Married | 57.0 (54.7–59.2) | 59.8 (52.3–67.3) | 56.8 (54.5–59.1) | 36.9 (31.8–41.9) ** | 45.4 (43.0–47.9) |
Widowed | 17.5 (16.1–18.9) | 25.7 (20.7–30.8) ** | 17.0 (15.6–18.5) | 17.4 (13.9–21.0) | 21.6 (19.7–23.6) |
Divorced | 14.8 (13.1–16.5) | 9.7 (6.3–14.8) | 15.1 (13.4–16.9) | 20.6 (16.3–24.9) | 18.5 (16.4–20.6) |
Separated | 2.3 (1.8–2.8) | 1.1 (0.5–2.8) | 2.3 (1.9–2.9) | 9.5 (6.4–14.0) | 3.7 (2.8–4.9) |
Never Married | 5.6 (4.7–6.6) | 1.4 (0.5–4.1) | 5.8 (5.0–6.8) | 10.0 (7.2–13.5) | 8.1 (6.6–10.1) |
Living with Partner | 2.8 (2.3–3.6) | 2.2 (0.6–7.7) | 2.9 (2.3–3.6) | 5.6 (3.6–8.7) | 2.6 (2.0–3.4) |
Smoking (current %, 95% CI) | 15.9 (14.2–17.60 | 11.2 (8.5–15.9) | 16.2 (14.4–17.9) * | 35.5 (30.1–40.9) ** | 17.9 (15.6–20.3) |
Body Mass Index (%, 95% CI) | |||||
Normal Weight < 25 | 31.9 (30.3–33.5) | 38.8 (30.4–47.2) * | 31.5 (29.8–33.3) | 19.3 (13.5–25.1) * | 24.3 (22.4–26.1) |
Overweight = 25–29.9 | 29.8 (27.9–31.6) | 23.0 (17.9–29.0) | 30.1 (28.1–32.1) | 24.9 (19.0–30.9) | 28.7 (26.9–30.5) |
Obese = 30–39.9 | 30.1 (28.8–31.5) | 29.5 (23.8–35.1) | 30.2 (28.7–31.7) | 37.7 (32.9–42.5) | 35.9 (33.7–38.0) |
Morbidly Obese = BMI ≥ 40 | 8.2 (7.3–9.2) | 8.3 (4.3–15.4) | 8.2 (7.3–9.1) | 18.1 (14.2–22.0) | 11.1 (9.4–12.9 |
Anemia (yes, %, 95% CI) | 26.4 (23.7–29.0) | 29.4 (22.7–36.2) | 26.2 (23.4–29.0) | 33.1 (27.2–39.1) | 34.0 (30.9–37.2) |
Cardiovascular Disease (%, 95% CI) | 12.8 (11.4–14.2) | 15.9 (10.4–21.5) * | 12.6 (11.1–14.1) | 24.4 (19.6–29.2) ** | 14.9 (13.1–16.7) |
Chronic Kidney Disease (%, 95% CI) | 18.8 (17.3–20.3) | 36.4 (27.8–45.0) ** | 17.9 (16.5–19.3) | 9.6 (6.6–13.8) | 18.6 (16.2–21.0) ** |
Depression (%, 95% CI) | 12.7 (11.5–13.9) | 10.9 (4.5–17.3) | 12.8 (11.5–14.1) | N/A | N/A |
All deaths (N, %) | 1159 (24.6) | 104 (43.4) ** | 1055 (23.58) | 117 (24.4) | 594 (23.5) |
Predictors of Mortality | Total Population HR (95% CI) BC vs. No BC | Breast Cancer Only HR (95% CI) | Depression Only HR (95% CI) | Breast Cancer and Depression HR (95% CI) |
---|---|---|---|---|
Comparison groups | 1.50 (1.05–2.13) * | 1.45 (0.99–2.12) | 1.43 (1.09–1.86) * | 3.04 (1.16–8.01) ** |
Cardiovascular Disease (No = ref) | 2.43 (2.04–2.91) ** | 2.42 (2.00–2.91) ** | 2.36 (1.92–2.90) ** | 2.01 (1.05–3.85) * |
CKD (No = ref) | 1.41 (1.03–1.92) * | 1.34 (1.00–1.81) | 1.51 (1.08–2.11) * | 2.42 (1.01–5.79) * |
Anemia (No = ref) | 1.71 (1.40–2.09) ** | 1.63 (1.32–2.01) ** | 1.73 (1.38–2.16) ** | 2.19 (1.21–3.98) * |
Obesity (No = ref) | 1.30 (1.02–1.66) * | 1.24 (0.94–1.62) | 1.32 (1.03–1.69) * | 2.34 (1.04–5.23) * |
Smoking Status (No = ref) | 1.57 (1.30–1.89) ** | 1.55 (1.23–1.97) ** | 1.55 (1.28–1.87) ** | 1.70 (1.01–2.92) * |
Age (years) | 1.09 (1.07–1.11) ** | 1.10 (1.08–1.12) ** | 1.09 (1.07–1.11) ** | 1.08 (1.05–1.12) ** |
Family Poverty-Income-Ratio (Ref: PIR ≥ 1) | 1.53 (1.22–1.91) ** | 1.33 (1.03–1.71) * | 1.51 (1.19–1.92) * | 2.49 (1.32–4.68) * |
Health Insurance (yes = ref) | 1.25 (0.82–1.88) | 1.24 (0.74–2.79) | 1.20 (0.79–1.82) | 0.97 (0.44–02.180) |
Education Level | ||||
Some College and Beyond | Ref | Ref | Ref | Ref |
Some High School | 1.29 (1.00–1.66) | 1.33 (0.99–1.79) | 1.36 (1.03–1.78) | 0.78 (0.47–1.32) |
High School Graduate | 1.01 (0.84–1.28) | 1.07 (0.86–1.34) | 1.10 (0.87–1.38) | 0.58 (0.29–1.16) |
Race/Ethnicity | ||||
Non-Hispanic White | Ref | Ref | Ref | Ref |
Non-Hispanic Black | 0.81 (0.63–1.05) | 0.80 (0.60–1.07) | 0.78 (0.59–1.04) | 0.89 (0.38–2.08) |
Hispanic | 0.54 (0.34–0.84) * | 0.60 (0.38–0.97) * | 0.49 (0.33–0.74) * | 0.34 (0.13–0.87) * |
Other | 0.56 (0.26–1.18) | 0.45 (0.16–1.26) | 0.54 (0.25–1.16) | 0.77 (0.33–1.76) |
Marital Status (ref = married/with partner) | 1.44 (1.18–1.76) ** | 1.59 (1.28–1.97) * | 1.34 (1.10–1.63) * | 1.64 (1.44–1.94) * |
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Khubchandani, J.; Banerjee, S.; Batra, K.; Beydoun, M.A. Depression Is Associated with a Higher Risk of Mortality among Breast Cancer Survivors: Results from the National Health and Nutrition Examination Survey–National Death Index Linked Study. Brain Sci. 2024, 14, 732. https://doi.org/10.3390/brainsci14070732
Khubchandani J, Banerjee S, Batra K, Beydoun MA. Depression Is Associated with a Higher Risk of Mortality among Breast Cancer Survivors: Results from the National Health and Nutrition Examination Survey–National Death Index Linked Study. Brain Sciences. 2024; 14(7):732. https://doi.org/10.3390/brainsci14070732
Chicago/Turabian StyleKhubchandani, Jagdish, Srikanta Banerjee, Kavita Batra, and May A. Beydoun. 2024. "Depression Is Associated with a Higher Risk of Mortality among Breast Cancer Survivors: Results from the National Health and Nutrition Examination Survey–National Death Index Linked Study" Brain Sciences 14, no. 7: 732. https://doi.org/10.3390/brainsci14070732