The influence of depression on esophageal cancer outcomes: Using the National Inpatient Sample (NIS) 2021.

Abstract

338 Background: Esophageal cancer (EC) remains a challenging malignancy with high morbidity and mortality rates. Depression is prevalent among cancer patients and has been shown to affect various clinical outcomes. This study aims to evaluate the impact of depression on mortality, length of stay (LOS), and hospitalization charges in patients with esophageal cancer using data from the NIS. Methods: We conducted a retrospective, population-based study using the NIS data to analyze patients diagnosed with esophageal cancer. Depression was the primary exposure variable using the appropriate ICD-10 code. We applied survey-weighted descriptive statistics, logistic regression, and linear regression models to assess outcomes, adjusting for demographic and clinical factors, including age, sex, race, comorbidities (Charlson Comorbidity Index), hospital teaching status, and regional characteristics. Results: A total of 40,855 patients with esophageal cancer were included, with 11.4% (n = 4,855) having a concurrent diagnosis of depression. The unadjusted mortality rate for the cohort was 9.18%, with depressed patients showing a lower mortality rate (6.45% vs. 9.53%, p = 0.0018). After adjusting for covariates, depression was associated with significantly lower in-hospital mortality (adjusted OR 0.63, 95% CI 0.48–0.83, p = 0.001). While the unadjusted mean length of stay (LOS) was slightly higher in depressed patients (7.66 vs. 7.25 days, p = 0.132), adjusted models showed no significant difference (β = 0.42 days, p = 0.132). Depression was associated with lower unadjusted total hospitalization charges ($92,321 vs. $104,156, p = 0.023), and in adjusted analyses, depressed patients incurred significantly lower costs (β = -$10,327, 95% CI -$19,233 to -$1,421, p = 0.023). Significant predictors of increased hospitalization charges included teaching hospital status (β = $34,029, p < 0.0001) and large hospital size (β = $38,481, p < 0.0001). Conclusions: Depression, while common among patients with esophageal cancer, was unexpectedly associated with lower in-hospital mortality, despite a longer length of stay and higher comorbidity burden. This suggests that depressed patients may receive more comprehensive or prolonged care, which could contribute to their reduced mortality risk. Additionally, despite extended hospital stays, these patients incurred significantly lower hospitalization costs, indicating possible differences in resource utilization or treatment intensity. These findings highlight the complex relationship between mental health and cancer outcomes, emphasizing the need for further research to explore the mechanisms behind these associations and to better tailor care for esophageal cancer patients with depression.