Disparities in the prevalence of anxiety and major depressive disorder in patients with lung cancer and the associated risk factors: A retrospective analysis.
Authors: Li Vivian , Javaid Saad , Frasier Kelly , Vinagolu-Baur Julia , Ortega Yaguachi Nataly , Rodriguez Evadne , Del Castillo Olivia , Batista Raquel , Jonas Kenlee , Palma Laura 
Published: June 2024

e22544 Background: Cancer is a leading cause of mortality and has been associated with an increasing prevalence of psychological disorders. Previous studies indicate that approximately 1 in 8 individuals diagnosed with lung cancer also experience symptoms of depression. Our study aimed to assess the disparities in the prevalence and association of Anxiety and Major depressive disorder (MDD) in lung cancer patients. Methods: Using the National Inpatient Sample 2017-2020, we identified lung cancer patients with regional and advanced metastatic disease. They were divided into two groups - with and without concomitant Anxiety and MDD. Baseline demographic characteristics were analyzed to assess disparities in prevalence, and multivariate logistic regression was used to evaluate the association of Anxiety and MDD in these patients. Results: A total of 461975 patients had lung cancer, and 25780(5%) had concurrent diagnoses of Anxiety and MDD. The anxiety + MDD group had 70% females and 30% males (p < 0.001).Females had an increased likelihood of MDD + Anxiety (OR = 2.36 (2.21-2.52); p < 0.001). Compared to younger patients, older patients were less likely to have MDD + Anxiety ( > 65: OR = 0.45(0.25-0.81); p = 0.008). Compared to the white population, patients of other races had a decreased likelihood of MDD + Anxiety (Black: OR = 0.41( 0.36-0.47), p < 0.001; Hispanic: OR = 0.65( 0.55-0.77), p < 0.001; Other races OR = 0.60(0.48-0.76), p < 0.001). Private insurance and patients without insurance were less likely to have MDD + Anxiety (OR = 0.74(0.67-0.81) and OR = 0.56(0.44-0.71), p < 0.001, respectively). Patients admitted to teaching and large hospitals had an increased likelihood of MDD + Anxiety compared to smaller and nonteaching hospitals (OR = 1.13(1.03-1.24), p = 0.006 and OR = 1.14(1.03-1.25), p = 0.007, respectively). Patients with Hyperlipidemia, Hypertension, COPD, and Obesity were more likely to have MDD + Anxiety (OR = 1.39(1.30-1.48), p < 0.001; OR = 1.11(1.03-1.18), p = 0.002; OR = 1.29(1.21-1.38), p < 0.001 and OR = 1.33(1.22-1.45), p < 0.001 respectively). In contrast, patients with Diabetes had a decreased likelihood of concomitant Anxiety + Depression (OR = 0.92(0.85-0.99), p = 0.04). Lung cancer patients with concurrent Anxiety + MDD had a higher total cost of hospitalization. (+$ 2611(66-5156); p = 0.04). Conclusions: Female lung cancer patients and white individuals had an increased risk of anxiety and depression. Patients with private insurance had decreased risk, and those admitted to larger and teaching hospitals had increased association with these psychological disorders. Devising comprehensive strategies to effectively control underlying psychiatric conditions is crucial for improving outcomes in lung cancer patients, aiming to enhance quality of life and prolong life expectancy.