Disparities in Depression Among Older Asian, Native Hawaiian, and Pacific Islander Patients With Lung Cancer

Approximately 12.4% of patients with lung cancer experience depression after cancer diagnosis. Asian, Native Hawaiian, and Pacific Islanders (ANHPIs) constitute a large group with heterogeneity. The aim of this study is to examine the racial differences in depression risk, comparing overall ANHPI and ANHPI ethnic groups to non-Hispanic White (NHW) patients with lung cancer.

We utilized the Surveillance, Epidemiology and End Results (SEER)-Medicare and SEER-Consumer Assessment of Healthcare Providers and System (CAHPS) dataset. We included patients with primary lung cancer who were aged 66 and older, diagnosed from 2000 to 2017 with full coverage of Medicare Part A and B. One ANHPI patient with lung cancer was matched to three NHW patients with lung cancer based on sex, diagnosis age, and diagnosis year. We used the Cox proportional hazards model to estimate the differences in depression incidence among ANHPI and NHW patients with lung cancer.

Overall ANHPI, Chinese, Japanese, Filipino, Asian Indian or Pakistani, and other Asian patients with lung cancer had a lower incidence of depression than NHW patients with lung cancer. Korean patients with lung cancer (HR 1.62, 95% CI 1.05-2.51) had a higher incidence of depression when compared to Chinese patients with lung cancer. ANHPI and NHW males had a lower incidence of depression compared to female lung cancer patients.

Korean patients with lung cancer may have a higher incidence of depression than Chinese comparisons. More research to investigate the heterogeneity and underdiagnosis of depression risk among older ANHPI groups is needed.