Objective: Incidence rates of lung cancer (LC) are reported to have declined in the nation. However, the role of depression and tobacco history relative to hospitalization cost for LC remains unknown. Tennessee, being a tobacco producing State, provides an opportunity to examine two issues: (i) Prevalence of LC, depression, and history of tobacco use among LC patients by race and gender; (ii) Effect of depression and smoking history on hospitalization costs by sub-groups of LC patients.

Methods: We extracted data pertaining to depression, smoking history, and demographics on patients discharged with all lung cancer (adenocarcinoma, ICD-9 codes 160-165) from the 2008 Tennessee Hospital Discharge Data System (HDDS). The sample (n = 6,665) had patients that were mostly white (86%) and male (57%), with an average age of 67 years. We computed age-adjusted LC rates for race and gender (per CDC methodology), and compared the costs for LC patients with depression/ smoking history with LC patients without depression/smoking history.

Results: LC rates (per 100K) were higher among blacks than whites (146.6 vs. 131.6, p<.000), and higher among male than female patients (174.9 vs. 118.0, p<.00). While nearly 40% of LC patients had a smoking history (more males than females had a history with no racial variation), 25% had depression (more females and whites were depressed). Further, the total hospitalization cost for 2008 was 50% higher for LC patients with depression plus smoking history compared to peers without depression/smoking history ($122,500 vs. 80,522, p<.000).

Conclusion: LC rates are higher among blacks and males who also have more smoking history. Depression is higher among females and whites with LC. Further, both depression and smoking history adds significantly to the hospitalization costs. These results point to: (i) costs savings might be realized by treating depression first among the LC patients, and (ii) population-based smoking cessation programs need to be vigorously implemented to reduce lung cancer and associated co-morbidities.


This presentation at the Eight AACR annual Conference, New Orleans, April 16-20, 2016, was partially supported by grants from CDC #U58CCU422782, a sub-contract #ED-07-20811-09, and a NCI/NIH grant (5U54CA163066) to Tennessee State University, B. Husaini, PI.

Citation Format: Baqar A. Husaini, Van A. Cain, Robert S. Levine. Race and gender differences in lung cancer: examining the effect of smoking history and depression on hospitalization costs. [abstract]. In: Proceedings of the 107th Annual Meeting of the American Association for Cancer Research; 2016 Apr 16-20; New Orleans, LA. Philadelphia (PA): AACR; Cancer Res 2016;76(14 Suppl):Abstract nr 1796A.