Health Resources and Services Administration, Office of Health Equity, Rockville, MD and Oak Ridge Institute for Science and Education (ORISE), Oak Ridge, TN, USA.
US Department of Health and Human Services, Health Resources and Services Administration, Office of Health Equity, Rockville, MD, USA.
Ann Behav Med. 2021 Jun 28;55(7):621-640. doi: 10.1093/abm/kaaa111.
BACKGROUND/PURPOSE: Psychological distress can influence cancer mortality through socioeconomic disadvantage, health-risk behaviors, or reduced access to care. These disadvantages can result in higher risks of cancer occurrence, a delayed cancer diagnosis, hamper adherence to treatment, and provoke inflammatory responses leading to cancer. Previous studies have linked psychological distress to cancer mortality. However, studies are lacking for the U.S. population.
This study examines the Kessler six-item psychological distress scale as a risk factor for U.S. cancer mortality using the pooled 1997-2014 data from the National Health Interview Survey (NHIS) linked to National Death Index (NDI) (N = 513,012). Cox proportional hazards regression was used to model survival time as a function of psychological distress and sociodemographic and behavioral covariates.
In Cox models with 18 years of mortality follow-up, the cancer mortality risk was 80% higher (hazard ratio [HR] = 1.80; 95% CI = 1.64, 1.97) controlling for age; 61% higher (HR = 1.61; 95% CI = 1.46, 1.76) in the SES-adjusted model, and 33% higher (HR = 1.33; 95% CI = 1.21, 1.46) in the fully-adjusted model among adults with serious psychological distress (SPD), compared with adults without psychological distress. Males, non-Hispanic Whites, and adults with incomes at or above 400% of the federal poverty level had greater cancer mortality risk associated with SPD. Using an 8 years of mortality follow-up, those with SPD had 108% increased adjusted risks of mortality from breast cancer.
Our study findings underscore the significance of addressing psychological well-being in the population as a strategy for reducing cancer mortality.
背景/目的：心理困扰可能通过社会经济劣势、健康风险行为或降低获得治疗的机会，影响癌症死亡率。这些劣势可能导致癌症发生风险增加、癌症诊断延迟、治疗依从性受损，并引发炎症反应，导致癌症。先前的研究已经将心理困扰与癌症死亡率联系起来。然而，针对美国人群的研究还很缺乏。
本研究使用来自国家健康访谈调查（NHIS）与国家死亡指数（NDI）链接的 1997-2014 年的汇总数据（N = 513,012），使用 Kessler 六项目心理困扰量表来检验心理困扰在美国癌症死亡率中的风险因素。Cox 比例风险回归用于将生存时间建模为心理困扰以及社会人口学和行为协变量的函数。
在具有 18 年死亡率随访的 Cox 模型中，控制年龄因素后，癌症死亡率风险增加 80%（风险比 [HR] = 1.80；95%置信区间 [CI] = 1.64，1.97）；在 SES 调整模型中，癌症死亡率风险增加 61%（HR = 1.61；95% CI = 1.46，1.76）；在完全调整模型中，严重心理困扰（SPD）成年人的癌症死亡率风险增加 33%（HR = 1.33；95% CI = 1.21，1.46），与没有心理困扰的成年人相比。男性、非西班牙裔白人和收入达到或超过联邦贫困水平 400%的成年人与 SPD 相关的癌症死亡率风险更高。在进行 8 年的死亡率随访后，患有 SPD 的成年人死于乳腺癌的调整后风险增加了 108%。
我们的研究结果强调了在人群中关注心理健康作为降低癌症死亡率的策略的重要性。
