Disparities in Depression: The Role of Race and Gender in Patients with Myeloproliferative Neoplasms, an Analysis of the National Inpatient Sample (NIS) (2016-2020)

Introduction

There is a high prevalence of depression and anxiety among patients with myeloproliferative neoplasms (MPN) (9-30%), affecting compliance with treatment and regular physician visits. A growing body of data suggests that female gender, low education level, non-white race, physical symptom burden, and concomitant comorbidities are associated with more severe distress, depression, and anxiety in these patients. Consequently, we sought to examine racial and gender-based differences in the prevalence of depression in patients with MPN in a large national sample.

Methods

We conducted a retrospective study utilizing National Inpatient Sample data from 2016 to 2020 and utilized the International Classification of Diseases, 10th revision codes to include adult patients (18 years or older) with a history of MPN during hospitalization. We also identified patients who had a concomitant diagnosis of depression. The cohort was divided between MPN patients with depression and those without. Baseline characteristics were identified and compared between the two groups. Comorbidities, race, median household income, and rates of concomitant anxiety were identified. Analysis was performed with STATA, and a 2-sided P< 0.05 was considered statistically significant.

Results

There were a total of 747,605 hospitalizations of patients with a history of MPN. Of those, 6,878 had depression, and 97,095 had anxiety. Significant differences were observed in patients who had depression, such as prevalence was higher in whites (74.48%) compared to 12.50% in African-Americans, 9.30% in Hispanics, and 1.93% in Asians (p<0.001). Patients with MPN who had depression were more likely to be female (65.19%, p<0.001), had higher rates of anxiety (28% vs. 13%, p<0.001), and obesity (15% vs. 13%, p<0.001) than patients who did not have depression. Type of insurance and region of the hospital was significantly associated with depression, being most prevalent in those with Medicare (53%; p<0.001), Medicaid (22%; p<0.001), and in the Midwest (30%; p<0.001) and South (29%; p<0.001). Notably, depression was also more prevalent in patients between the 0-25th percentile of median household income for the patient's zip code (27%) compared to the 76th to 100th percentile (20.82%)(p=0.05). Interestingly, comorbidities such as anemia, heart failure, venous thromboembolism, and stroke were not significantly associated with depression (p=0.25, p=0.36, p=0.25, and stroke p=0.40, respectively).

Conclusion

Overall, the prevalence of depression and anxiety was high in patients with MPN, and higher in patients of White race, female gender, with obesity. Medicare insurance, the Midwest region, and being in the 0-25th percentile median household income were also associated with higher rates of depression. Our results highlight the need for further research into social, gender, and racial factors in MPN patients with depression in order to improve compliance with treatment and reduce the disease burden.