Background/Purpose Psychological distress can influence cancer mortality through socioeconomic disadvantage, health-risk behaviors, or reduced access to care. These disadvantages can result in higher risks of cancer occurrence, a delayed cancer diagnosis, hamper adherence to treatment, and provoke inflammatory responses leading to cancer. Previous studies have linked psychological distress to cancer mortality. However, studies are lacking for the U.S. population. Methods This study examines the Kessler six-item psychological distress scale as a risk factor for U.S. cancer mortality using the pooled 1997–2014 data from the National Health Interview Survey (NHIS) linked to National Death Index (NDI) (N = 513,012). Cox proportional hazards regression was used to model survival time as a function of psychological distress and sociodemographic and behavioral covariates. Results In Cox models with 18 years of mortality follow-up, the cancer mortality risk was 80% higher (hazard ratio [HR] = 1.80; 95% CI = 1.64, 1.97) controlling for age; 61% higher (HR = 1.61; 95% CI = 1.46, 1.76) in the SES-adjusted model, and 33% higher (HR = 1.33; 95% CI = 1.21, 1.46) in the fully-adjusted model among adults with serious psychological distress (SPD), compared with adults without psychological distress. Males, non-Hispanic Whites, and adults with incomes at or above 400% of the federal poverty level had greater cancer mortality risk associated with SPD. Using an 8 years of mortality follow-up, those with SPD had 108% increased adjusted risks of mortality from breast cancer. Conclusion Our study findings underscore the significance of addressing psychological well-being in the population as a strategy for reducing cancer mortality.

中文翻译：

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美国心理困扰与癌症死亡率之间的关联：1997-2014 年 NHIS-NDI 记录关联研究的结果

背景/目的 心理压力可以通过社会经济劣势、健康风险行为或减少获得护理的机会来影响癌症死亡率。这些缺点会导致更高的癌症发生风险、延迟癌症诊断、妨碍治疗的依从性以及引发导致癌症的炎症反应。先前的研究已将心理困扰与癌症死亡率联系起来。然而，缺乏针对美国人群的研究。方法 本研究使用与全国死亡指数 (NDI) (N = 513,012) 相关的全国健康访谈调查 (NHIS) 的 1997-2014 年汇总数据，检查凯斯勒六项心理困扰量表作为美国癌症死亡率的风险因素。Cox 比例风险回归用于模拟生存时间作为心理困扰和社会人口学和行为协变量的函数。结果 在 18 年死亡率随访的 Cox 模型中，控制年龄，癌症死亡风险高出 80%（风险比 [HR] = 1.80；95% CI = 1.64, 1.97）；在 SES 调整模型中高出 61% (HR = 1.61; 95% CI = 1.46, 1.76)，在完全调整模型中高出 33% (HR = 1.33; 95% CI = 1.21, 1.46)与没有心理困扰的成年人相比，心理困扰（SPD）。男性、非西班牙裔白人和收入达到或超过联邦贫困线 400% 的成年人与 SPD 相关的癌症死亡风险更高。使用 8 年的死亡率随访，患有 SPD 的患者因乳腺癌死亡的调整后风险增加了 108%。