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Table 2 Independent association of healthy lifestyle score and mental health a with mortality among US cancer survivors, and mediation proportion of lifestyle inequity in mortality attributed to mental health

From: Combined lifestyle, mental health, and mortality in US cancer survivors: a national cohort study

 

Unweighted total cases/deaths

HR (95% CI)

Mediation proportion (%)

(95% CI)

Model 1b

Model 2c

Model 3 d

All-cause mortality

 Healthy lifestyle score

  0–1

1206/341

1.00 (Reference)

1.00 (Reference)

1.00 (Reference)

 

  2

1132/308

0.91 (0.75–1.10)

0.94 (0.78–1.13)

0.93 (0.77–1.11)

6.2 (3.1–9.3)

  3–5

807/170

0.61 (0.50–0.76)

0.68 (0.55–0.84)

0.69 (0.56–0.85)

7.8 (3.9–11.7)

 Per 1-point increase

 

0.85 (0.79–0.91)

0.88 (0.82–0.94)

0.89 (0.83–0.95)

 

 PHQ-9 score

   ≥ 10

318/72

1.00 (Reference)

1.00 (Reference)

1.00 (Reference)

 

  5–9

495/140

0.85 (0.58–1.24)

0.90 (0.62–1.30)

0.92 (0.63–1.33)

 

  0–4

2332/607

0.61 (0.46–0.81)

0.68 (0.51–0.91)

0.70 (0.52–0.93)

 

 Per 5-point decrease

 

0.79 (0.71–0.87)

0.83 (0.74–0.92)

0.83 (0.74–0.93)

 

Cancer mortality

 Healthy lifestyle score

  0–1

1206/122

1.00 (Reference)

1.00 (Reference)

1.00 (Reference)

 

  2

1132/106

0.91 (0.65–1.29)

0.95 (0.68–1.35)

0.95 (0.68–1.34)

1.2 (0.6–1.8)

  3–5

807/54

0.63 (0.42–0.96)

0.69 (0.45–1.05)

0.69 (0.46–1.05)

1.6 (0.8–2.4)

 Per 1-point increase

 

0.84 (0.73–0.98)

0.87 (0.76–1.00)

0.87 (0.76–1.00)

 

 PHQ-9 score

   ≥ 10

318/29

1.00 (Reference)

1.00 (Reference)

1.00 (Reference)

 

  5–9

495/46

1.26 (0.70–2.27)

1.31 (0.74–2.33)

1.34 (0.75–2.40)

 

  0–4

2332/207

0.91 (0.51–1.63)

1.00 (0.54–1.86)

1.02 (0.55–1.90)

 

 Per 5-point decrease

 

0.94 (0.75–1.18)

0.97 (0.76–1.24)

0.98 (0.76–1.25)

 

Non-cancer mortality

 Healthy lifestyle score

  0–1

1206/219

1.00 (Reference)

1.00 (Reference)

1.00 (Reference)

 

  2

1132/202

0.91 (0.72–1.14)

0.92 (0.74–1.14)

0.90 (0.73–1.11)

8.3 (4.1–12.2)

  3–5

807/116

0.60 (0.46–0.78)

0.67 (0.51–0.88)

0.68 (0.52–0.89)

10.3 (5.2–15.3)

 Per 1-point increase

 

0.85 (0.77–0.93)

0.88 (0.80–0.98)

0.89 (0.80–0.98)

 

 PHQ-9 score

   ≥ 10

318/43

1.00 (Reference)

1.00 (Reference)

1.00 (Reference)

 

  5–9

495/94

0.67 (0.43–1.04)

0.73 (0.46–1.15)

0.74 (0.47–1.17)

 

  0–4

2332/400

0.49 (0.35–0.67)

0.56 (0.40–0.79)

0.57 (0.40–0.80)

 

 Per 5-point decrease

 

0.71 (0.63–0.81)

0.76 (0.67–0.85)

0.76 (0.67–0.86)

 
  1. aMental health was assessed by a 9-item depression screening instrument, the Patient Health Questionnaire (PHQ-9). The cut-off of 5–9 and ≥ 10 was used to define the presence of mild and major depression, respectively
  2. bModel 1 was adjusted for age at the time of interview, sex, education level, ratio of family income to poverty, race and ethnicity, sleep duration, prevalent diabetes, hypertension, dyslipidemia, history of cardiovascular disease
  3. cModel 2 was additionally adjusted for the number of cancer types and age at the first cancer diagnosis
  4. dModel 3 was additionally adjusted for PHQ-9 score or healthy lifestyle score, in regard to the association of healthy lifestyle score and mental health with mortality, respectively
  5. PHQ Patient Health Questionnaire, HRs hazard ratios, CIs confidence interval
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Journal of Translational Medicine

ISSN: 1479-5876

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