Breast Cancer Research and Treatment

, Volume 174, Issue 1, pp 237–248 | Cite as

A nationwide study of breast cancer, depression, and multimorbidity among hospitalized women and men in the United States

  • Roger J. ZoorobEmail author
  • Jason L. Salemi
  • Maria C. Mejia de Grubb
  • Sanjukta Modak
  • Robert S. Levine



Breast cancer is the most common and second most deadly cancer for women in the US. Comorbidities like depression exacerbate the burden. This national study provides data on depression and comorbidity for both women and men with breast cancer.


We conducted a serial cross-sectional analysis of the 2002–2014 National Inpatient Sample, the largest all-payer inpatient discharge database in the United States. We identified patients with primary site breast cancer, and captured information on their concomitant depression and other major chronic comorbidities. Logistic regression was used to generate adjusted odds ratios representing associations between patient and hospital characteristics and depression. Joinpoint regression was used to estimate temporal trends in depression rates.


Depression prevalence was higher for women than men, with little difference between cancer subtypes. Comorbidity burden was nearly twice as high for men. From 2002 to 2014, the average number of comorbidities doubled. Depression rates were highest for patients with four or more chronic comorbidities and those with unplanned hospitalizations. Significant yearly increases of 6–10% in depression were also observed.


Breast cancer patient depression rates were higher than the general inpatient population with a strong gradient effect between increasing numbers of comorbidities and the odds of depression. Comorbidities, including mental health-related, negatively impact breast cancer prognosis, increasing cancer-specific mortality as well as mortality for other conditions. Unplanned hospitalization episodes in a patient with breast cancer can be noted as an opportunity for mental health screening and intervention.


Breast cancer Depression Comorbidity HCUP NIS 


Author contributions

RZ was the primary contributing author and participated in writing all sections of the manuscript and conceptualization of the study. JS led the study design and served as database manager and lead statistician, as well as participating in drafting the methods and results sections. SM assisted in statistical analysis, writing the methods and results sections, and preparing figures and tables. MDG participated in writing the manuscript, reviewing literature, organizing references and introduction and conclusion sections. RL was instrumental in the conceptualization of the study design and served as editor and methodology evaluator. All authors contributed significantly to the study design, writing, analysis, and read and approved the final manuscript.

Compliance with ethical standards

Competing interests

The authors of this work certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge, or beliefs) in the subject matter or materials discussed in this manuscript.

Ethical approval

NIS data are de-identified and publicly available. The Baylor College of Medicine Institutional Review Board classified this study as exempt.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Family and Community MedicineBaylor College of MedicineHoustonUSA

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