Residents of low-income, rural areas at higher risk for suicide after cancer diagnosis
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Patients with cancer who resided in low-income and rural areas appeared at higher risk for suicide than those in high-income and urban areas, according to a retrospective, population-based study in JAMA Network Open.
Researchers called for an effort to provide psychological services to address these disparities.
“[Patients with cancer] and cancer survivors face many complex challenges, particularly those living in rural or low-income areas,” Ryan Suk, PhD, MS, assistant professor in the department of management, policy and community health at University of Texas Health Science Center at Houston School of Public Health, told Healio.
Because previous research had shown elevated suicide risk among people with cancer and cancer survivors, as well as a lack of mental health care providers in low-income or rural areas, Suk and colleagues hypothesized those living in low-income or rural areas would have greater risk for suicide after cancer diagnosis.
The analysis included 5,362,782 people (51.2% men; 72.2% white; 49.7% aged older than 65 years) diagnosed with cancer between 2000 and 2016 and living in 635 counties throughout the U.S. Researchers collected data from SEER 18 registries on people diagnosed with a first primary malignant tumor and made comparisons with the general U.S. population based on mortality data from the National Center for Health Statistics.
Standardized mortality ratios (SMRs) of suicide deaths and annual percentage changes (APCs) of SMRs served as the study’s primary outcome.
Results showed 6,357 people died of suicide. Among them, 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 = 1.3; 95% CI, 1.26-1.34). Additionally, those living in rural counties had a significantly higher risk (SMR = 1.81; 95% CI, 1.7-1.92) than those living in urban counties (SMR = 1.35, 95% CI, 1.32-1.39).
Suk and colleagues also estimated population-level disparities in suicide risk across different area-level characteristics among patients with cancer and cancer survivors.
“One individual-level attribute that surprised us was Asian and Pacific Islander,” Suk said. “Suicide risk in this population was consistently high across all income areas; even those who lived in the highest-income counties had a nearly twofold increased risk for suicide mortality compared with the general population.”
The individual finding, Suk said, was “significantly different” from other race and ethnicity groups, among whom results showed significantly higher suicide mortality in lower-income areas vs. higher-income areas.
“This finding may highlight the need to disseminate more information about mental health services to individuals with cancer in this demographic,” Suk said.
Among all county groups, SMRs were highest within the first year following cancer diagnosis. Yet, the risk remained significantly high even 10 or more years after cancer diagnosis for those in the lowest-income counties (SMR, 1.83; 95% CI, 1.31-2.48).
Within 1 year following cancer diagnosis, the comparative risk for suicide decreased significantly, but then plateaued in the highest-income (2005-2015: APC = 2.03%, 95% CI, –0.97 to 5.13), lowest income (2010-2015: APC = 4.8%; 95% CI, –19.97 to 37.24) and rural counties (2004-2015: APC = 1.83%; 95% CI, –1.98 to 5.79).
“Enhancing telemedicine services might help address these disparities and improve mental health among people diagnosed with cancer,” Suk said. “I would like to see more studies evaluating the effectiveness and cost-effectiveness of telemedicine for psychosocial services in cancer care and survivorship care.”
For more information:
Ryan Suk, PhD, MS, can be reached at Center for Health Systems Research, Policy and Practice, Department of Management, Policy and Community Health, University of Texas Health Science Center at Houston School of Public Health, 1200 Pressler St., RAS-E 915, Houston, TX 77030; email: ryan.suk@uth.tmc.edu.
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