The paradoxical impact of depression on mortality, length of stay, and hospitalization charges in patients with prostate and bladder cancer: Using the 2021 NIS database.

Abstract

e17148 Background: Depression is a prevalent comorbidity in patients with cancer, potentially influencing treatment outcomes. This study evaluates the association of depression with mortality, length of stay (LOS), and hospitalisation charges (TOTCHG) among patients with prostate cancer and bladder cancer. Methods: We conducted a retrospective analysis of the NIS 2021 database. Hospitalised patients with prostate cancer, bladder cancer and depression were identified using the appropriate ICD-10 codes. Survey-weighted descriptive statistics were utilized to analyze patient demographics, mortality rates, LOS, and TOTCHG. Multivariable logistic and linear regression models evaluated the impact of depression on outcomes, adjusting for age, sex, race, income quartiles, Charlson comorbidity index, hospital region, teaching status, and bed size. Results: In this study, 182,280 hospitalised prostate cancer patients and 40,855 hospitalised bladder cancer patients were analyzed. Among prostate cancer patients, 9.3% (16,785 patients) were depressed, with depressed individuals slightly younger (adjusted coefficient -0.42 years, p=0.036), predominantly White (76.2%, p<0.001), privately insured (76.1%, p<0.001), with higher comorbidity (85.9%, p<0.001), & in the Midwest region (25.9%, p<0.001). Among bladder cancer patients, 11.4% (4,645 patients) were depressed, with depression more common in younger individuals (adjusted coefficient -1.07 years, p=0.004), women (31.4%, p<0.001), White patients (86.9%, p<0.001), those with higher comorbidity (85.8%, p<0.001), Northeast (29.1%, p=0.019) and privately insured (63.2%). Depressed prostate cancer patients had lower mortality rates (3.75% vs. 4.67%, adjusted OR 0.76, p=0.004), shorter hospital stays (5.33 vs 6.13 days, adjusted - 0.72 days, p<0.001), & lower hospitalization charges ($73,977 vs. $85,966, adjusted reduction -$11,699, p<0.001). Depressed bladder cancer patients had lower mortality rates (6.45% vs. 9.53%, adjusted OR 0.63, p=0.001), slightly shorter hospital stays (7.25 vs. 7.66 days, adjusted - 0.42 days, p=0.032), and reduced hospitalization charges ($92,321 vs. $104,156, adjusted reduction -$10,327, p=0.023). Conclusions: This study reveals that depression was more prevalent in younger, White, privately insured patients with higher comorbidities. Interestingly, depressed patients in both cohorts had lower mortality rates, shorter hospital stays, and reduced hospitalisation charges despite their higher comorbidity burdens, suggesting potential differences in healthcare utilisation, disease management, or psychosocial factors. These findings underscore the importance of recognising and addressing depression, as it may not only affect patient quality of life but also play a significant role in shaping clinical and economic outcomes.