Abstract
Studies suggest the risk of suicide among people with cancer diagnosis is higher compared with the general population. However, little is known about how suicide risk among people diagnosed with cancer might vary according to area-level income and rurality. To examine whether the risks and patterns of suicide mortality among people with a cancer diagnosis differ by US county-level median income and rural or urban status. A retrospective, population-based cohort study following up individuals who were diagnosed with cancer between January 1, 2000, and December 31, 2016, was conducted. The Surveillance, Epidemiology, and End Results Program 18 registries (SEER 18) database was used to obtain data on persons diagnosed with a first primary malignant tumor. Comparisons with the general US population were based on mortality data collected by the National Center for Health Statistics. Analyses were conducted from February 22 to October 14, 2020. County-level median household income and urban or rural status. Standardized mortality ratios (SMRs) of suicide deaths and annual percentage changes (APCs) of SMRs. The SEER 18 database included 5 362 782 persons with cancer diagnoses living in 635 counties. Most study participants were men (51.2%), White (72.2%), and older than 65 years (49.7%). Among them, 6357 persons died of suicide (SMR, 1.41; 95% CI, 1.38-1.44). People with cancer living in the lowest-income counties had a significantly higher risk (SMR, 1.94; 95% CI, 1.76-2.13) than those in the highest-income counties (SMR, 1.30; 95% CI, 1.26-1.34). Those living in rural counties also had significantly higher SMR than those in urban counties (SMR, 1.81; 95% CI, 1.70-1.92 vs SMR, 1.35; 95% CI, 1.32-1.39). For all county groups, the SMRs were the highest within the first year following cancer diagnosis. However, among people living in the lowest-income counties, the risk remained significantly high even after 10 or more years following cancer diagnosis (SMR, 1.83; 95% CI, 1.31-2.48). The comparative risk of suicide mortality within 1 year following cancer diagnosis significantly decreased over the years but then plateaued in the highest-income (2005-2015: APC, 2.03%; 95% CI, -0.97% to 5.13%), lowest-income (2010-2015: APC, 4.80%; 95% CI, -19.97% to 37.24%), and rural (2004-2015: APC, 1.83; 95% CI, -1.98% to 5.79%) counties. This cohort study showed disparities in suicide risks and their patterns among people diagnosed with cancer by county-level income and rural or urban status. The findings suggest that additional research and effort to provide psychological services addressing these disparities among people with cancer may be beneficial.
Highlights
Among people living in the lowest-income counties, the risk remained significantly high even after 10 or more years following cancer diagnosis (SMR, 1.83; 95% CI, 1.31-2.48)
The comparative risk of suicide mortality within 1 year following cancer diagnosis significantly decreased over the years but plateaued in the highest-income (2005-2015: annual percentage changes (APCs), 2.03%; 95% CI, −0.97% to 5.13%), lowest-income (2010-2015: APC, 4.80%; 95% CI, −19.97% to 37.24%), and rural (2004-2015: APC, 1.83; 95% CI, −1.98% to 5.79%) counties
This cohort study showed disparities in suicide risks and their patterns among people diagnosed with cancer by county-level income and rural or urban status
Summary
Despite recent improvements in rates of cancer survival, deaths from suicide among people with cancer continue to be higher than the general population in the US.[1,2,3,4] Both individual-level sociodemographic (age, sex, economic status, and marital status) and clinical (depression, cancer site, and time since diagnosis) risk factors are associated with suicide among people with cancer.[2,3,5,6] In particular, depression, one of the most common psychiatric complications among people with cancer, has been reported to increase the risk of mortality by nearly 40%.7-9 the determinants of depressive disorders among people diagnosed with cancer are likely multifactorial, some risk factors for suicide may be more prevalent among people with cancer: functional impairment, poorer social and family well-being, and lower socioeconomic status.[8,10] Data suggest financial insolvency contributes to early mortality among people with cancer. Despite recent improvements in rates of cancer survival, deaths from suicide among people with cancer continue to be higher than the general population in the US.[1,2,3,4] Both individual-level sociodemographic (age, sex, economic status, and marital status) and clinical (depression, cancer site, and time since diagnosis) risk factors are associated with suicide among people with cancer.[2,3,5,6] In particular, depression, one of the most common psychiatric complications among people with cancer, has been reported to increase the risk of mortality by nearly 40%.7-9. Ramsey et al[11] reported that filing bankruptcy was associated with a 79% increase in early mortality among people with cancer. These findings imply that social and economic status may be important factors in understanding the higher rates of suicide among people with cancer
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