Abstract 5770: The relationship between psychological distress and cancer mortality in the United States: Results from the 1997-2014 NHIS-NDI record linkage study
Authors: Lee Hyunjung , Singh Gopal K. 
Published: September 2020

Abstract
Background
Psychological distress can influence death from cancer through social or economic disadvantage, health-risk behaviors, or reduced access to care. These disadvantages can result in higher risks of cancer occurrence, a delayed diagnosis of cancer, hamper adherence to treatment, and potentially provoke inflammatory responses that result in cancer. Previous studies have demonstrated an association between psychological distress including depression and anxiety with all-cause mortality, and especially cancer mortality. While two studies found that people in the highest distress category had higher rates of mortality from selected cancers relative to those in the lowest distress category in the UK population, there is a lack of studies among the U.S. population. Accordingly, this study examines this relationship in the U.S. population.
Method
This study examines the Kessler 6-item psychological distress scale as a risk factor for cancer mortality during 1997-2014 using national representative survey data. We linked pooled data from the 1997 to 2014 National Health Interview Survey (NHIS) with mortality records in the National Death Index (NDI) (N = 513,081). Cox proportional hazards regression analysis was used to model time to death as a function of psychological distress and sociodemographic and behavioral covariates.
Results
In Cox proportional hazards regression models, the cancer mortality risk was 80% higher (hazard ratio [HR] = 1.80; 95% CI: 1.64, 1.97) in adults with serious psychological distress (SPD) (p&lt;0.001), controlling for age, and 61% higher (HR = 1.61; 95% CI: 1.46, 1.76) in adults with SPD (p&lt;0.001), controlling for demographic and socioeconomic characteristics such as age, gender, race/ethnicity, immigrant status, education, marital status, poverty status, housing tenure, and geographic region, when compared to adults without SPD. The association (HR = 1.02, 95% CI: 0.93, 1.12) between SPD and cancer mortality was accounted for after controlling for additional covariates including health-risk behaviors (smoking status and alcohol consumption) and health status (poor health status, activity limitation, and BMI).
Conclusions
With 18 years of follow-up in this nationally representative study, we found that adults with serious psychological distress had statistically significant higher relative risks of cancer mortality in the United States than adults without SPD. These findings underscore the significance of addressing psychological well-being in the general population and the cancer-patient population as a strategy for reducing cancer mortality.
Key words Psychological distress, cancer mortality, NHIS-NDI, longitudinal, social determinants
Citation Format: Hyunjung Lee, Gopal K. Singh. The relationship between psychological distress and cancer mortality in the United States: Results from the 1997-2014 NHIS-NDI record linkage study [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 5770.