Koric Alzina, Chang Chun-Pin Esther, Lee Yuan-Chin Amy, Wei Mei, Lee Catherine, Wang Jing, Hashibe Mia
Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, Saint Louis, MO, United States.
Huntsman Cancer Institute, University of Utah School of Medicine, Salt Lake City, UT, United States.
JNCI Cancer Spectr. 2025 Jul 1;9(4). doi: 10.1093/jncics/pkaf066.
Longitudinal studies examining mental health outcomes among older (≥66 years) Asian, Native Hawaiian, and Pacific Islander (ANHPI) women diagnosed with breast cancer are limited. We evaluated incident depression after breast cancer among specific groups of older ANHPI compared with older non-Hispanic White (NHW) women. Predictors of depression and the risk of death following early onset of depression after breast cancer were also evaluated.
A cohort of 26 776 older ANHPI women in the United States diagnosed with breast cancer between 2000 and 2017 was identified from the SEER-Medicare linked claims. There were 6694 older ANHPI and 20 082 older NHW women diagnosed with breast cancer. Adjusted hazard ratios (HRs) were calculated with the Cox proportional hazards regression and 99% confidence intervals (CI) to evaluate incident depression and death among older ANHPI compared with age-matched NHW counterparts.
Compared with older NHW women with breast cancer, older Japanese (HR = 0.43, 99% CI = 0.31 to 0.66), Chinese (HR = 0.46, 99% CI = 0.31 to 0.67), Filipino (HR = 0.43, 99% CI = 0.30 to 0.60), and Asian Indian/Pakistani women (HR = 0.49, 99% CI = 0.28 to 0.84) had a lower risk of depression overall and within 5 years of follow-up; lower risk persisted for Japanese and Chinese women >5 years. ANHPI breast cancer patients with early onset of depression had a higher risk of death (HR = 1.46, 99% CI = 1.30 to 1.65) compared to those without depression.
Compared with older NHW women, older ANHPI women had a lower incidence of depression, although disentangling the stigma surrounding depression by race and ethnicity remains challenging.
针对被诊断患有乳腺癌的老年（≥66岁）亚洲、夏威夷原住民和太平洋岛民（ANHPI）女性心理健康状况的纵向研究有限。我们评估了特定老年ANHPI群体与老年非西班牙裔白人（NHW）女性相比，乳腺癌后的新发抑郁症情况。还评估了抑郁症的预测因素以及乳腺癌后抑郁症早期发作后的死亡风险。
从SEER - Medicare关联索赔中识别出2000年至2017年间在美国被诊断患有乳腺癌的26776名老年ANHPI女性队列。其中有6694名老年ANHPI和20082名老年NHW女性被诊断患有乳腺癌。采用Cox比例风险回归计算调整后的风险比（HRs）和99%置信区间（CI），以评估老年ANHPI与年龄匹配的NHW女性相比的新发抑郁症和死亡情况。
与患有乳腺癌的老年NHW女性相比，老年日本女性（HR = 0.43，99% CI = 0.31至0.66）、中国女性（HR = 0.46，99% CI = 0.31至0.67）、菲律宾女性（HR = 0.43，99% CI = 0.30至0.60）以及亚洲印度/巴基斯坦女性（HR = 0.49，99% CI = 0.28至0.84）总体上以及在随访5年内患抑郁症的风险较低；日本和中国女性在随访超过5年后风险持续较低。与未患抑郁症的ANHPI乳腺癌患者相比，早期患抑郁症的患者死亡风险更高（HR = 1.46，99% CI = 1.30至1.65）。
与老年NHW女性相比，老年ANHPI女性抑郁症发病率较低，尽管按种族和民族区分抑郁症相关的耻辱感仍然具有挑战性。
