Cancer, depression, and health care coverage in the state of Nevada: A retrospective cross-sectional study.

42 Background: The prevalence of depressive disorders in patients with malignancies is estimated at 20-50%, significantly greater than the general population. Existing literature reports a negative impact of depression on both the patient and their families. There is limited information regarding the impact of healthcare coverage on the prevalence of depression in such patients both in the state of Nevada and nationwide. Methods: A retrospective cross-sectional study was performed using the Behavioral Risk Surveillance System (BRFSS) database from 2010 to 2014. All adult subjects with a history of malignancy were included. Demographic factors and health care coverage were reviewed. Individuals with skin cancer as well as those with missing data were excluded. Patients were assigned to two groups based on their insurance coverage status. Study population was further stratified into Nevada and non-Nevada residents and analyzed. Association between depression and health care coverage across the study groups were assessed using Pearson chi-square test and regression models. Results: 183,530 subjects nationwide met our inclusion criteria. The Nevada population represented 1% (1676) of the total study sample. In Nevada, the prevalence of cancer patients without healthcare coverage was 7.5% (N = 126) compared to individuals with coverage 92% (N = 1550). This is significantly higher when compared to the national average of 4.9 % without coverage (p = 0.001). Overall, the rate of depression in cancer patients with no healthcare coverage nationally was notably higher compared to those with coverage (37.5% vs 22.7%, p = 0.001). Similarly, statistically higher rates of depression were noted in non-insured Nevada patients compared to those insured [49 (38.8%) vs. 357 (23%), p 0.001)]. Conclusions: This study demonstrates significant association between depression and lack of insurance coverage; both nationwide as well as in the state of Nevada. The proportion of uninsured Nevada residents with malignancies were higher compared to the national average. Improved and early screening for depression is crucial in mitigating the potential complications and morbidity associated with depression in patients with cancer.