Table 3.
Hazard ratios (95% confidence intervals) of depression, anxiety, and stress-related disorders during the year after cancer diagnosis in relation to pre-diagnostic exclusive use of aspirin, analysis by recency of use, daily dose, and duration of use
| Characteristics | 1000 PYs | Event (IR) | Model 1a | Model 2b | Model 3c |
|---|---|---|---|---|---|
| No NSAIDs (reference group) | 174 | 3408 (19.6) | 1.00 | 1.00 | 1.00 |
| Recency of aspirin use | |||||
| Previous | 12 | 229 (19.1) | 1.02 (0.89–1.18) | 1.02 (0.88–1.18) | 1.01 (0.88–1.17) |
| Current | 38 | 568 (15.1) | 0.82 (0.74–0.91) | 0.81 (0.73–0.90) | 0.84 (0.75–0.93) |
| Daily dose of aspirin use | |||||
| Low-dose | 40 | 659 (16.4) | 0.87 (0.79–0.97) | 0.87 (0.78–0.96) | 0.88 (0.80–0.98) |
| Medium dose | 6 | 90 (15.8) | 0.95 (0.76–1.18) | 0.94 (0.75–1.17) | 0.96 (0.77–1.19) |
| High dose | 1 | 18 (19.9) | 1.17 (0.73–1.86) | 1.16 (0.72–1.84) | 1.17 (0.73–1.86) |
| Duration of aspirin use | |||||
| Short-term | 10 | 210 (20.6) | 1.07 (0.93–1.25) | 1.06 (0.92–1.24) | 1.07 (0.92–1.25) |
| Long-term | 37 | 557 (15.2) | 0.83 (0.74–0.92) | 0.82 (0.74–0.91) | 0.84 (0.76–0.94) |
| Combined regimens | |||||
| Previous, low-dose | 10 | 195 (19.3) | 1.03 (0.88–1.21) | 1.02 (0.87–1.19) | 1.02 (0.87–1.19) |
| Previous, medium-high dose | 2 | 30 (17.8) | 1.09 (0.75–1.57) | 1.06 (0.74–1.53) | 1.04 (0.72–1.49) |
| Current, low-dose, long-term | 26 | 362 (14.2) | 0.76 (0.67–0.86) | 0.75 (0.66–0.85) | 0.77 (0.68–0.87) |
| Current, low-dose, short-term | 5 | 102 (22.1) | 1.15 (0.94–1.41) | 1.13 (0.92–1.38) | 1.16 (0.94–1.42) |
| Current, medium-high dose, long-term | 4 | 65 (15.5) | 0.94 (0.73–1.21) | 0.92 (0.71–1.18) | 0.95 (0.74–1.23) |
| Current, medium-high dose, short-term | 1 | 13 (18.1) | 1.04 (0.60–1.80) | 1.02 (0.59–1.76) | 1.05 (0.61–1.82) |
Recency was defined by the time since last dispensed date to cancer diagnosis and patients were classified into previous users (more than 90 days before cancer diagnosis) and current users (within 90 days before cancer diagnosis). A total dispensed dose of aspirin, average daily dose, and number of days to be covered were calculated according to prescription text. Average daily dose was then categorized as low (20–150 mg), medium (151–300 mg), and high (> 300 mg) dose. Long-term users were defined as those who used aspirin for ≥ 300 days during the 365 days before cancer diagnosis. IRs were calculated by dividing the number of patients that received a diagnosis of depression, anxiety, and stress-related disorders by the number of person-years accumulated during follow-up. Combined regimens across recency, dose, and duration were also examined. Hazard ratios and 95% confidence intervals were estimated from separate Cox proportional hazard models to assess the effect of recency, dose, and duration of use, as well as the six combined regimens of aspirin use, using no use of NSAIDs as the reference
Abbreviations: PYs person-years, IR incidence rate per 1000 person-years
aEstimates were adjusted for age, sex, calendar year at cancer diagnosis, educational level, occupation, region of residence, marital status, and Chronic Disease Score
bEstimates were additionally adjusted for potential indications for NSAID use
cEstimates were additionally adjusted for common cancer types and cancer stage, as well as subtypes of hematological malignancies (leukemia, lymphoma, myeloma, myelodysplastic syndrome, or myeloproliferative neoplasm)