Socioeconomic predictors of suicide risk among cancer patients in the United States: A population-based study

Objective: To assess the socioeconomic predictors of suicide risk among cancer patients in the United States. Methods: Cancer patients available within Surveillance, Epidemiology and End Results (SEER) database who were diagnosed between 2000-2010 have been reviewed. Linkage analysis to Census 2000 SF files was conducted to determine area-based socioeconomic attributes. Observed/ Expected ratios were calculated for the overall cohort as well as for clinically and socioeconomically defined subgroups. "Observed" is the number of observed completed suicide cases in the studied cohort; while "Expected" is the number of completed suicide cases in a demographically similar cohort within the United States and within the same period of time. Results: The current study reviews a total of 3,149,235 cancer patients (diagnosed 2000-2010) within the SEER database. Regarding socioeconomic county attributes, higher risk of suicide seems to be associated with lower educational attainment (O/E for counties with > 20% individuals with less than high school education: 1.41; 95% CI: 1.35-1.47), poverty rates (O/E for counties with > 5% individuals below poverty line: 1.39; 95% CI: 1.34-1.43), unemployment rates (O/E for counties with > 5% families below poverty line: 1.36; 95% CI: 1.31-1.41) and less people living in urban areas (O/E for counties with <= 50% individuals living in urban areas: 1.63; 95% CI: 1.50-1.77). On the other hand, risk of suicide seems to be inversely related to a higher representation of foreign-born individuals (O/E for counties with <= 5% foreign-born individuals: 1.56; 95% CI: 1.47-1.65); and inversely related to a higher representation with recent immigrants to the US (O/E for counties with <= 5% recent immigrants: 1.33; 95% CI: 1.29-1.38). Conclusions: Cancer patients living in a socioeconomically vulnerable environment (lower educational status, poverty, and unemployment) seem to have higher suicide risk compared to other cancer patients.