ISRN Psychiatry

Volume 2013 (2013), Article ID 901987, 3 pages

http://dx.doi.org/10.1155/2013/901987

Research Article

No Association between Depression and Risk of Hepatocellular Carcinoma in Older People in Taiwan

Shih-Wei Lai,1,2 Cheng-Li Lin,3,4 Kuan-Fu Liao,5,6 and Wen-Chi Chen5,7

¹School of Medicine, China Medical University, Taichung 404, Taiwan

²Department of Family Medicine, China Medical University Hospital, Taichung 404, Taiwan

³Department of Public Health, China Medical University, Taichung 404, Taiwan

⁴Management Office for Health Data, China Medical University Hospital, Taichung 404, Taiwan

⁵Graduate Institute of Integrated Medicine, China Medical University, Taichung 404, Taiwan

⁶Department of Internal Medicine, Taichung Tzu Chi General Hospital, No. 66, Sec. 1, Fongsing Road, Tanzi District, Taichung 427, Taiwan

⁷Department of Urology, China Medical University Hospital, Taichung 404, Taiwan

Received 3 September 2013; Accepted 21 October 2013

Academic Editors: A. Michael and H. P. Volz

Copyright © 2013 Shih-Wei Lai et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract.

Objectives. The objective of this study was to determine whether there is a relationship between depression and risk of hepatocellular carcinoma (HCC) in older people in Taiwan. Methods. A case-control study was conducted to analyze the database from the Taiwan National Health Insurance program. We selected 1815 subjects aged 65 years or older with newly diagnosed HCC as the case group and 7260 subjects without HCC as the comparison group, from 2000 to 2010. Both groups were compared to measure the risk of HCC. Results. After controlling for confounders, the odds ratio of HCC was 0.81 in subjects with depression (95% confidence interval = 0.59, 1.11), as compared with nondepressed subjects. Conclusions. We conclude that no association is detected between depression and risk of hepatocellular carcinoma in older people in Taiwan.

1. Introduction

Until now, controversies exist regarding the relationship between depression and subsequent cancer risk. That is, some studies showed an increased risk [1, 2], but others showed no increased risk [3, 4]. Similarly, no specific evidence is available about the relationship between depression and risk of hepatocellular carcinoma (HCC) in older people. In order to explore this issue, a population-based case-control study was conducted to analyze the database from the Taiwan National Health Insurance program.

2. Methods

The details of the Taiwan National Health Insurance program can be documented in previous studies [5–7]. In this case-control study, we randomly selected 1815 subjects aged 65 years or older with newly diagnosed HCC as the case group (1132 men and 683 women, mean age 74.31 years, and standard deviation 6.29 years) (according to the International Classification of Diseases 9th Revision-Clinical Modification, ICD-9 codes 155, 155.0, and 155.2) and 7260 subjects without HCC as the comparison group (4528 men and 2732 women, mean age 74.09 years, and standard deviation 6.53 years). Both groups were matched with sex, age, and index year of diagnosing HCC, from 2000 to 2010. The index date was defined as the date of diagnosing HCC. In order to reduce the confounding effects, subjects with any cancer (ICD-9 codes 140–208), major psychiatric diseases (ICD-9 codes 291–293, 294.0, 294.8-294.9, 295, 296.0-296.1, 296.4–296.9, and 297-298), other dementia (290.0–290.4, and 294.1), or mental retardation (ICD-9 codes 317–319) diagnosed before the index date were excluded. Depression (ICD-9 codes 331.0) and other comorbidities potentially associated with HCC were diagnosed before the index date [7].

3. Results

We compared the basic characteristics and co-morbidities between the HCC group and the comparison group. Table 1 shows that the HCC group was more likely to have diabetes mellitus, cirrhosis, other chronic hepatitis, hepatitis B infection, hepatitis C infection, and alcoholism, with statistical significance. There were 114 subjects with depression among the HCC group (6.28%) and 385 subjects with depression among the comparison group (5.30%), without significant difference (). After controlling for confounding factors, multivariable logistic regression analysis demonstrated that the odds ratio (OR) of HCC was 0.81 in subjects with depression (95% confidence interval (CI) = 0.59, 1.11), as compared with nondepressed subjects (Table 2).

Table 1: Characteristics between hepatocellular carcinoma group and comparison group.

Hepatocellular carcinoma
P value

No 
Yes  

= 7260
= 1815

(%)

(%)

Age group (year)

    65–74
4260
58.68
1065
58.68
0.99

    75–84
3000
41.32
750
41.32

Sex

    Men
4528
62.37
1132
62.37
0.99

    Women
2732
37.63
683
37.63

Comorbidities before index date*

    Depression
385
5.30
114
6.28
0.10

    Diabetes mellitus
1941
26.74
636
35.04
<0.0001

    Cirrhosis
137
1.89
990
54.56
<0.0001

    Other chronic hepatitis
1163
16.02
1033
56.91
<0.0001

    Hepatitis B infection
112
1.54
361
19.89
<0.0001

    Hepatitis C infection
135
1.86
600
33.06
<0.0001

    Alcoholism
57
0.79
24
1.32
0.03

Data are presented as the number of subjects in each group, with percentages given in parentheses.

Chi-square test comparing subjects with and without hepatocellular carcinoma.

*Comorbidities included before index date were as follows: depression (ICD-9 codes 296.2-296.3, 300.4, and 311), diabetes mellitus (ICD-9 codes 250), cirrhosis (ICD-9 codes 571.2, and 571.5-571.6), other chronic hepatitis (ICD-9 codes 571.40-571.41, 571.49, and 571.8-571.9), hepatitis B infection (ICD-9 codes V02.61, 070.20, 070.22, 070.30, and 070.32), hepatitis C infection (ICD-9 codes V02.62, 070.41, 070.44, 070.51, and 070.54), and alcoholism (ICD-9 codes 303, 305.00, 305.01, 305.02, 305.03, and V11.3).

Table 2: Odds ratio and 95% confidence interval of hepatocellular carcinoma associated with depression and other comorbidities.

Variable
Crude
Adjusted†

OR
(95% CI)
OR
(95% CI)

Age (per one year)
1.01
(1.00, 1.01)
1.04
(1.03, 1.05)

Comorbidities before index date (yes versus no)

    Depression
1.20
(0.97, 1.49)
0.81
(0.59, 1.11)

    Diabetes mellitus
1.48
(1.33, 1.65)
1.04
(0.89, 1.22)

    Cirrhosis
62.39
(51.46, 75.65)
28.55
(23.17, 35.19)

    Other chronic hepatitis
6.93
(6.19, 7.75)
2.23
(1.89, 2.63)

    Hepatitis B infection
15.84
(12.72, 19.73)
5.87
(4.40, 7.84)

    Hepatitis C infection
26.06
(21.42, 31.72)
7.72
(6.00, 9.93)

    Alcoholism
1.70
(1.05, 2.74)
0.85
(0.43, 1.68)

Adjusted for age, diabetes mellitus, cirrhosis, other chronic hepatitis, hepatitis B infection, hepatitis C infection, and alcoholism.

4. Discussion

To date, there is no consensus about the association between depression and subsequent cancer risk [1–4]. One cohort study by Chen and Lin in Taiwan showed that patients with depression correlate with 1.8-fold increased risk of gastrointestinal cancer (95% CI = 1.03, 3.14), but HCC is not mentioned specifically [2]. In the present study, despite the fact that we controlled the comorbidities potentially associated with HCC, no association is detected between depression and HCC risk in older people (OR = 0.81, 95% CI = 0.59, 1.11). Generally speaking, 70–90% of all HCC cases are significantly associated with cirrhosis or other chronic the liver diseases worldwide [8]. Depression is a mood disorder, not causing chronic inflammation of liver. Therefore, these two diseases should have their unique pathogenesis without potential linking. Since formal depression diagnostic procedures were not recorded in this database, more prospective studies are necessary to validate our findings.

Conflict of Interests

The authors disclose no conflict of interests.

Authors’ Contribution

Shih-Wei Lai: contributed substantially to the conception of this paper conducted the study, interpreted the data, initiated the draft of the paper and critically revised the article. Cheng-Li Lin conducted the statistical analysis and critically revised it. Kuan-Fu Liao and Wen-Chi Chen conducted the study and critically revised the paper.

Acknowledgment

The authors would like to thank the National Health Research Institute in Taiwan for providing the insurance claims data. This study was supported in part by Taiwan Department of Health Clinical Trial and Research Center of Excellence (DOH 102-TD-B-111-004) and China Medical University Hospital (Grant no. 1MS1). The funding agency did not influence the study design, data collection and analysis, decision to publish, or preparation of the paper.

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