Racial differences in the incidence of mental health illness among ovarian cancer patients: An analysis of SEER-Medicare data

Abstract

Background: Ovarian cancer (OC) patients have an increased risk for a mental health illness (MHI) after their cancer diagnosis, but limited research exists on whether this risk differs by race/ethnicity. Hence, we used SEER-Medicare data to evaluate racial/ethnic differences in MHI incidence among OC patients aged 65+.

Methods: Non-Hispanic (NH) Black, NH White, and Hispanic women diagnosed with OC in 2008-2015 without a mental health history 12 months prior to their cancer diagnosis were identified from SEER-Medicare. Cox proportional hazards regression evaluated new MHI incidence in the first five years post diagnosis and the differences by race/ethnicity. Hazard ratios (HR) and 95% confidence intervals (CI) adjusted for demographic/clinical covariates and healthcare access (HCA) dimensions.

Results: We identified 5441 OC patients, including 364 NH Black (6.7%), 4982 NH White (91.6%), and 95 Hispanic (1.7%) patients. About 41% of NH White, 33.3% of NH Black, and 37.2% of Hispanic OC patients were diagnosed with MHI during the follow-up period between 2008 and 2016. In the fully adjusted model, NH Black OC patients were less likely to be diagnosed with any MHI (aHR: 0.67, 95% CI: 0.54, 0.82), depression (aHR: 0.66, 95% CI: 0.51, 0.86), and anxiety disorder (aHR: 0.64, 95% CI: 0.49, 0.84), while Hispanic OC patients were less likely to be diagnosed with anxiety disorder (aHR: 0.56, 95% CI: 0.33, 0.95) compared to NH White OC patients.

Discussion: NH Black OC patients are less likely to receive a clinical MHI diagnosis compared to NH White OC patients. Further studies on racial differences in MHI incidence after OC diagnosis in primary cohorts are needed to better estimate population-level prevalence less vulnerable to exposure misclassification and to account for patient-level factors impacting MHI.

Keywords: Healthcare access; Mental health; Mental health diagnosis; Ovarian cancer; Racial disparities.

Fig. 1.

Flowchart showing sample size attrition to attain final sample size for study cohort of ovarian cancer patients in SEER-Medicare 2008–2015.

Fig. 2.

Cumulative incidence curves for diagnosis with mental health conditions over six years from index ovarian cancer diagnosis in different panels; i) any mental health illness, ii) anxiety disorder, iii) depression, iv) adjustment disorder, v) bipolar disorder, vi) schizophrenia, and vii) PTSD. P-values are from Grays’s test (two-sided), which compared cumulative curves in each panel by race and ethnicity; a significant P-value indicates that the cumulative incidence curves are not the same at all time-points considered. Line type: NH White = long-dash; NH Black = solid; Hispanic = short-dash.