Table 4:
Multivariable Analysis of Mental Illness Associated with Endocrine Therapy Initiation, Discontinuation, and Adherence
| Number with Illness | HR | HR | Estimate | ||
|---|---|---|---|---|---|
| cIntercept | - | - | - | 0.758 (0.748, 0.768) | |
| Emotional: | |||||
| Unipolar or Depression Adjustment Disorder | 2,473 (11.3%) | 0.97 (0.92–1.02) | 1.07 (0.92–1.13) | −0.007 (−0.016, 0.002) | |
| Anxiety | 2,089 (9.5%) | 1.01 (0.96–1.06) | **1.21 (1.09–1.34) | −0.003 (−0.012, 0.006) | |
| Cognitive: | |||||
| Delirium | 515 (2.4%) | 0.95 (0.85–1.06) | 1.04 (0.83–1.29) | 0.010 (−0.008, 0.029) | |
| Dementia | 1,017 (4.6%) | *0.90 (0.83–0.98) | 0.97 (0.83–1.15) | 0.011 (−0.002, 0.025) | |
| Personality | 59 (0.3%) | 0.87 (0.63–1.21) | 0.87 (0.46–1.63) | 0.017 (−0.031, 0.066) | |
| Substance Use (Alcohol, Drug) | 1,006 (4.6%) | 0.99 (0.92–1.06) | **1.43 (1.26–1.64) | **−0.023 (−0.037,–0.010) | |
| Bipolar and Psychoses (Bipolar Depression, Non-schizophrenia psychosis/Schizophrenia) | 1,259 (5.8%) | *0.93 (0.87–0.99) | 1.08 (0.94–1.24) | 0.004 (−0.008, 0.015) | |
| Stage at Diagnosis | |||||
| ref = 1 | 2 | **1.14 (1.10–1.18) | **0.80 (0.75–0.86) | 0.001 (−0.005, 0.006) | |
| 3 | 1.05 (0.99–1.11) | **0.72 (0.64–0.82) | *−0.012 (−0.023, –0.002) | ||
| 4 | **1.52 (1.31–1.76) | 1.19 (0.92–1.55) | *−0.049 (−0.080, –0.019) | ||
| Unknown | *0.86 (0.77–0.97) | 0.83 (0.66–1.04) | 0.001 (−0.018, 0.020) | ||
| Race | |||||
| ref = White | Asian | *1.09 (1.02–1.18) | *0.82 (0.71–0.96) | *0.012 (0.001, 0.023) | |
| Black | 0.96 (0.90–1.02) | **0.73 (0.63–0.84) | −0.009 (−0.020, 0.002) | ||
| Other | 0.98 (0.82–1.18) | 0.93 (0.63–1.38) | *–0.039 (−0.073, –0.005) | ||
| Ethnicity ref= Non-Hispanic | Hispanic | 1.00 (0.94–1.07) | *0.82 (0.71–0.94) | −0.003 (−0.014, 0.008) | |
| Age at Diagnosis | |||||
| ref= 68–74 | 75–84 | **0.92 (0.89–0.95) | **1.26 (1.18–1.34) | −0.002 (−0.008, 0.003) | |
| 85–94 | **0.65 (0.61–0.68) | **1.55 (1.41–1.71) | *0.012 (0.004, 0.021) | ||
| 95+ | **0.45 (0.34–0.60) | **2.61 (1.57–4.36) | −0.024 (−0.089, 0.041) | ||
| Adjusted NCI Comorbidity Score | 1.00 (0.99–1.01) | 1.00 (0.98–1.01) | 0.001 (−0.001, 0.002) | ||
| Year of Cancer Diagnosis | 2008 | 0.98 (0.92–1.05) | 0.95 (0.86–1.05) | 0.003 (−0.008, 0.014) | |
| ref= 2007 | 2009 | 1.01 (0.95–1.07) | *0.90 (0.81–1.00) | **0.024 (0.013, 0.034) | |
| 2010 | **1.11 (1.05–1.19) | *0.85 (0.76–0.95) | **0.059 (0.048, 0.070) | ||
| 2011 | **1.17 (1.09–1.24) | 0.90 (0.80–1.01) | **0.070 (0.060, 0.081) | ||
| 2012 | **1.15 (1.08–1.23) | 0.91 (0.80–1.03) | **0.086 (0.075, 0.096) | ||
| 2013 | **1.19 (1.12–1.27) | 0.92 (0.81–1.06) | **0.084 (0.072, 0.095) | ||
| cYear of Endocrine Therapy Use | 2 | - | - | **0.066 (0.062, 0.070) | |
| ref = 1 | 3 | - | - | **0.088 (0.084, 0.093) | |
| 4 | - | - | **0.118 (0.112, 0.124) | ||
| 5 | - | - | **0.130 (0.122, 0.138) | ||
*
<0.05,
**
<0.001, 95% confidence interval.
a
Discontinuation analyzed for the first 5 years of endocrine therapy use.
b
Proportion Days Covered (PDC) adherence was calculated in 1-year intervals, concluding after the 5th year of follow-up, if available. Individuals with less than 1 year of follow-up did not contribute to adherence values. Year adherence values not included if patient spent greater than half of that year hospitalized or in skilled nursing facilities. Adherence estimate of 0.01 corresponds to 1% change.
c
Intercept, year only apply to linear adherence model.