Socioeconomic predictors of suicide risk among cancer patients in the United States: A population-based study

Abstract

ObjectiveTo assess the socioeconomic predictors of suicide risk among cancer patients in the United States. MethodsCancer patients available within Surveillance, Epidemiology and End Results (SEER) database who were diagnosed between 2000–2010 have been reviewed. Linkage analysis to Census 2000 SF files was conducted to determine area-based socioeconomic attributes. Observed/ Expected ratios were calculated for the overall cohort as well as for clinically and socioeconomically defined subgroups. “Observed” is the number of observed completed suicide cases in the studied cohort; while “Expected” is the number of completed suicide cases in a demographically similar cohort within the United States and within the same period of time. ResultsThe current study reviews a total of 3,149,235 cancer patients (diagnosed 2000–2010) within the SEER database. Regarding socioeconomic county attributes, higher risk of suicide seems to be associated with lower educational attainment (O/E for counties with > 20% individuals with less than high school education: 1.41; 95% CI: 1.35–1.47), poverty rates (O/E for counties with > 5% individuals below poverty line: 1.39; 95% CI: 1.34–1.43), unemployment rates (O/E for counties with >5% families below poverty line: 1.36; 95% CI: 1.31–1.41) and less people living in urban areas (O/E for counties with < 50% individuals living in urban areas: 1.63; 95% CI: 1.50–1.77). On the other hand, risk of suicide seems to be inversely related to a higher representation of foreign-born individuals (O/E for counties with < 5% foreign-born individuals: 1.56; 95% CI: 1.47–1.65); and inversely related to a higher representation with recent immigrants to the US (O/E for counties with < 5% recent immigrants: 1.33; 95% CI: 1.29–1.38). ConclusionsCancer patients living in a socioeconomically vulnerable environment (lower educational status, poverty, and unemployment) seem to have higher suicide risk compared to other cancer patients.