Joint association of depressive symptoms and dietary patterns with mortality among US cancer survivors: a population-based study

Li, Zongyuan; Yu, Cheng; Hao, Jianqi; Shu, Yueli; Li, Jili; Zhang, Jian; Pu, Qiang; Liu, Lunxu

doi:10.1186/s12885-025-13945-z

Table 2 Association of PHQ-9 score and dietary health with all-cause, cancer, and noncancer mortality among US cancer survivors, NHANES 2005–2018

From: Joint association of depressive symptoms and dietary patterns with mortality among US cancer survivors: a population-based study

Mortality outcome	Death/No.	Weighted death (%)	Model 1		Model 2		Model 3
Mortality outcome	Death/No.	Weighted death (%)	HR (95% CI)	P value	HR (95% CI)	P value	HR (95% CI)	P value
All-cause mortality
PHQ-9 score
≥ 10	74/308	341,067 (18.2)	1 [Reference]		1 [Reference]		1 [Reference]
5–9	140/480	717,775 (22.8)	0.73 (0.48, 1.10)	0.127	0.89 (0.60, 1.33)	0.568	0.96 (0.64, 1.44)	0.842
0–4	572/2223	2,748,863 (17.8)	0.48 (0.35, 0.67)	< 0.001	0.67 (0.48, 0.93)	0.018	0.74 (0.53, 1.04)	0.080
HEI-2020
Low	286/1059	1,271,103 (18.7)	1 [Reference]		1 [Reference]		1 [Reference]
Intermediate	252/962	1,318,089 (19.3)	0.95 (0.76, 1.20)	0.681	1.09 (0.85, 1.38)	0.511	1.05 (0.84, 1.32)	0.675
High	248/990	1,218,513 (18)	0.66 (0.52, 0.82)	< 0.001	0.88 (0.68, 1.14)	0.322	0.83 (0.65, 1.08)	0.163
AHEI
Low	308/1068	1,386,527 (20.3)	1 [Reference]		1 [Reference]		1 [Reference]
Intermediate	258/1007	1,268,183 (18.7)	0.78 (0.64, 0.95)	0.013	0.92 (0.74, 1.13)	0.422	0.90 (0.73, 1.11)	0.346
High	220/936	1,152,995 (16.9)	0.61 (0.48, 0.78)	< 0.001	0.84 (0.65, 1.10)	0.204	0.82 (0.64, 1.07)	0.144
aMED
Low	400/1447	1,839,838 (19)	1 [Reference]		1 [Reference]		1 [Reference]
Intermediate	179/643	886,089 (21)	0.92 (0.71, 1.18)	0.492	1.04 (0.8, 1.35)	0.783	1.02 (0.78, 1.33)	0.909
High	207/921	1,081,778 (16.5)	0.62 (0.50, 0.76)	< 0.001	0.80 (0.64, 1.00)	0.051	0.81 (0.65, 1.02)	0.069
MEDI
Low	428/1509	2,016,594 (20.3)	1 [Reference]		1 [Reference]		1 [Reference]
Intermediate	224/867	1,109,435 (18.4)	0.87 (0.72, 1.06)	0.165	0.97 (0.80, 1.16)	0.713	0.92 (0.76, 1.11)	0.377
High	134/635	681,675 (15.3)	0.72 (0.58, 0.90)	0.004	0.96 (0.75, 1.21)	0.721	0.94 (0.74, 1.19)	0.597
DASH
Low	330/1204	1,476,138 (19.7)	1 [Reference]		1 [Reference]		1 [Reference]
Intermediate	243/903	1,168,859 (19)	0.73 (0.61, 0.86)	< 0.001	0.89 (0.74, 1.07)	0.221	0.86 (0.71, 1.04)	0.123
High	213/904	1,162,707 (17.1)	0.56 (0.44, 0.70)	< 0.001	0.79 (0.61, 1.03)	0.081	0.78 (0.60, 1.00)	0.054
DASHI
Low	269/1045	1,247,586 (18.3)	1 [Reference]		1 [Reference]		1 [Reference]
Intermediate	225/928	1,101,753 (16.2)	0.96 (0.76, 1.21)	0.750	1.11 (0.90, 1.38)	0.335	1.09 (0.88, 1.35)	0.451
High	292/1038	1,458,365 (21.4)	0.86 (0.69, 1.08)	0.199	1.07 (0.84, 1.36)	0.564	1.03 (0.82, 1.31)	0.773
DII
Low	224/916	1,179,275 (17.3)	1 [Reference]		1 [Reference]		1 [Reference]
Intermediate	260/993	1,243,275 (18.3)	1.11 (0.92, 1.35)	0.284	1.12 (0.91, 1.37)	0.289	1.15 (0.94, 1.40)	0.166
High	302/1102	1,385,154 (20.4)	1.31 (1.08, 1.59)	0.006	1.17 (0.90, 1.52)	0.236	1.22 (0.94, 1.58)	0.134
DII (No EtOH)
Low	225/930	1,174,171 (17.2)	1 [Reference]		1 [Reference]		1 [Reference]
Intermediate	259/991	1,257,313 (18.5)	1.14 (0.93, 1.39)	0.212	1.18 (0.98, 1.42)	0.081	1.18 (0.98, 1.42)	0.073
High	302/1090	1,376,221 (20.2)	1.33 (1.09, 1.63)	0.005	1.25 (0.97, 1.62)	0.086	1.29 (1.00, 1.67)	0.052
Cancer mortality
PHQ-9 score
≥ 10	28/308	104,728 (5.6)	1 [Reference]		1 [Reference]		1 [Reference]
5–9	46/480	228,739 (7.3)	0.95 (0.51, 1.77)	0.871	1.28 (0.69, 2.36)	0.431	1.32 (0.70, 2.51)	0.391
0–4	194/2223	903,677 (5.9)	0.67 (0.38, 1.18)	0.166	1.01 (0.58, 1.75)	0.971	1.05 (0.59, 1.87)	0.873
HEI-2020
Low	116/1059	494,699 (7.3)	1 [Reference]		1 [Reference]		1 [Reference]
Intermediate	68/962	330,043 (4.8)	0.63 (0.40, 0.97)	0.038	0.71 (0.45, 1.12)	0.139	0.71 (0.45, 1.12)	0.139
High	84/990	412,402 (6.1)	0.63 (0.44, 0.89)	0.010	0.85 (0.56, 1.28)	0.436	0.85 (0.56, 1.29)	0.446
AHEI
Low	110/1068	454,774 (6.7)	1 [Reference]		1 [Reference]		1 [Reference]
Intermediate	88/1007	398,275 (5.9)	0.77 (0.50, 1.19)	0.238	0.92 (0.59, 1.44)	0.728	0.93 (0.59, 1.45)	0.744
High	70/936	384,095 (5.6)	0.67 (0.45, 1.00)	0.050	0.95 (0.61, 1.49)	0.834	0.95 (0.60, 1.50)	0.833
aMED
Low	140/1447	555,327 (5.7)	1 [Reference]		1 [Reference]		1 [Reference]
Intermediate	65/643	342,582 (8.1)	1.25 (0.81, 1.95)	0.318	1.42 (0.92, 2.18)	0.113	1.39 (0.90, 2.15)	0.136
High	63/921	339,235 (5.2)	0.70 (0.48, 1.01)	0.057	0.93 (0.64, 1.36)	0.716	0.97 (0.66, 1.43)	0.880
MEDI
Low	138/1509	586,227 (5.9)	1 [Reference]		1 [Reference]		1 [Reference]
Intermediate	79/867	383,446 (6.4)	1.02 (0.75, 1.38)	0.907	1.13 (0.82, 1.56)	0.461	1.13 (0.84, 1.52)	0.429
High	51/635	267,471 (6)	0.95 (0.66, 1.36)	0.778	1.27 (0.86, 1.87)	0.235	1.29 (0.86, 1.92)	0.217
DASH
Low	130/1204	553,848 (7.4)	1 [Reference]		1 [Reference]		1 [Reference]
Intermediate	68/903	299,742 (4.9)	0.52 (0.39, 0.71)	< 0.001	0.65 (0.48, 0.86)	0.003	0.66 (0.49, 0.89)	0.006
High	70/904	383,554 (5.7)	0.54 (0.38, 0.76)	< 0.001	0.78 (0.53, 1.15)	0.213	0.78 (0.53, 1.15)	0.209
DASHI
Low	96/1045	427,615 (6.3)	1 [Reference]		1 [Reference]		1 [Reference]
Intermediate	75/928	343,012 (5)	0.83 (0.55, 1.25)	0.377	0.95 (0.62, 1.44)	0.796	0.94 (0.63, 1.41)	0.766
High	97/1038	466,517 (6.9)	0.86 (0.61, 1.20)	0.371	1.08 (0.76, 1.54)	0.669	1.07 (0.75, 1.53)	0.696
DII
Low	74/916	384,409 (5.6)	1 [Reference]		1 [Reference]		1 [Reference]
Intermediate	95/993	404,370 (5.9)	1.09 (0.79, 1.50)	0.603	1.14 (0.82, 1.58)	0.444	1.13 (0.81, 1.58)	0.462
High	99/1102	448,365 (6.6)	1.28 (0.91, 1.79)	0.156	1.20 (0.81, 1.78)	0.361	1.16 (0.79, 1.70)	0.439
DII (No EtOH)
Low	75/930	391,981 (5.8)	1 [Reference]		1 [Reference]		1 [Reference]
Intermediate	94/991	395,776 (5.8)	1.06 (0.76, 1.49)	0.726	1.13 (0.81, 1.58)	0.461	1.10 (0.79, 1.52)	0.573
High	99/1090	449,387 (6.6)	1.27 (0.90, 1.79)	0.169	1.24 (0.84, 1.84)	0.279	1.21 (0.82, 1.77)	0.344
Noncancer mortality
PHQ-9 score
≥ 10	46/308	236,339 (12.6)	1 [Reference]		1 [Reference]		1 [Reference]
5–9	94/480	489,036 (15.6)	0.64 (0.40, 1.01)	0.053	0.73 (0.47, 1.15)	0.181	0.81 (0.51, 1.28)	0.366
0–4	378/2223	1,845,186 (12)	0.41 (0.29, 0.60)	< 0.001	0.54 (0.36, 0.79)	0.002	0.62 (0.42, 0.92)	0.017
HEI-2020
Low	170/1059	776,403 (11.4)	1 [Reference]		1 [Reference]		1 [Reference]
Intermediate	184/962	988,046 (14.5)	1.16 (0.88, 1.51)	0.297	1.33 (1.00, 1.78)	0.052	1.27 (0.95, 1.69)	0.108
High	164/990	806,111 (11.9)	0.68 (0.52, 0.89)	0.005	0.91 (0.67, 1.22)	0.522	0.84 (0.63, 1.14)	0.265
AHEI
Low	198/1068	931,754 (13.6)	1 [Reference]		1 [Reference]		1 [Reference]
Intermediate	170/1007	869,908 (12.8)	0.79 (0.61, 1.01)	0.06	0.91 (0.69, 1.21)	0.531	0.90 (0.68, 1.18)	0.435
High	150/936	768,899 (11.3)	0.59 (0.44, 0.78)	< 0.001	0.80 (0.59, 1.08)	0.147	0.78 (0.57, 1.05)	0.104
aMED
Low	260/1447	1,284,510 (13.3)	1 [Reference]		1 [Reference]		1 [Reference]
Intermediate	114/643	543,507 (12.9)	0.78 (0.58, 1.04)	0.089	0.88 (0.65, 1.20)	0.418	0.86 (0.63, 1.17)	0.326
High	144/921	742,543 (11.3)	0.58 (0.47, 0.73)	< 0.001	0.74 (0.57, 0.96)	0.025	0.74 (0.57, 0.96)	0.023
MEDI
Low	290/1509	1,430,367 (14.4)	1 [Reference]		1 [Reference]		1 [Reference]
Intermediate	145/867	725,989 (12)	0.82 (0.64, 1.05)	0.113	0.91 (0.71, 1.16)	0.43	0.84 (0.66, 1.07)	0.156
High	83/635	414,204 (9.3)	0.63 (0.49, 0.82)	0.001	0.84 (0.64, 1.10)	0.207	0.81 (0.62, 1.07)	0.136
DASH
Low	200/1204	922,290 (12.3)	1 [Reference]		1 [Reference]		1 [Reference]
Intermediate	175/903	869,117 (14.1)	0.84 (0.67, 1.05)	0.127	1.02 (0.81, 1.30)	0.838	0.97 (0.76, 1.23)	0.781
High	143/904	779,153 (11.5)	0.57 (0.43, 0.77)	< 0.001	0.80 (0.58, 1.10)	0.173	0.78 (0.57, 1.06)	0.117
DASHI
Low	173/1045	819,971 (12)	1 [Reference]		1 [Reference]		1 [Reference]
Intermediate	150/928	758,741 (11.2)	1.04 (0.79, 1.37)	0.759	1.22 (0.95, 1.58)	0.124	1.20 (0.92, 1.55)	0.171
High	195/1038	991,848 (14.6)	0.86 (0.66, 1.13)	0.279	1.07 (0.79, 1.44)	0.666	1.02 (0.77, 1.35)	0.904
DII
Low	150/916	794,866 (11.7)	1 [Reference]		1 [Reference]		1 [Reference]
Intermediate	165/993	838,905 (12.3)	1.12 (0.85, 1.47)	0.408	1.11 (0.84, 1.46)	0.478	1.17 (0.89, 1.53)	0.265
High	203/1102	936,789 (13.8)	1.32 (1.02, 1.71)	0.037	1.15 (0.82, 1.61)	0.403	1.24 (0.89, 1.72)	0.207
DII (No EtOH)
Low	150/930	782,189 (11.5)	1 [Reference]		1 [Reference]		1 [Reference]
Intermediate	165/991	861,537 (12.7)	1.16 (0.88, 1.54)	0.284	1.20 (0.92, 1.57)	0.177	1.23 (0.95, 1.60)	0.121
High	203/1090	926,834 (13.6)	1.35 (1.04, 1.77)	0.025	1.26 (0.90, 1.75)	0.178	1.33 (0.95, 1.84)	0.093

Notes: Model 1: adjusted for age; Model 2: additionally adjusted for sex, race, BMI, education level, marital status, family income poverty ratio, health insurance coverage, smoking status, alcohol use, sleep duration, and energy intake; Model 3: additionally adjusted for hypertension, hypercholesterolemia, diabetes, CVD, the number of cancer types, and years since first cancer diagnosis. The dietary health indices were divided into low, intermediate and high categories based on the weighted tertile values
Abbreviations: PHQ-9 score, Patient Health Questionnaire-9 score; NHANES, the National Health and Nutrition Examination Survey; HR, hazard ratio; CI, confidence interval; BMI, body mass index; CVD, cardiovascular disease; HEI-2020, Healthy Eating Index-2020; HEI-2015, Healthy Eating Index-2015; AHEI, Alternative Healthy Eating Index; aMED, Alternate Mediterranean Diet Score; MEDI, MED Index in serving sizes from the PREDIMED trial; DASH, Dietary Approaches to Stop Hypertension Index; DASHI, DASH Index in serving sizes from the DASH trial; DII, Dietary Inflammation Index; EtOH, alcohol

Back to article page

ISSN: 1471-2407

Contact us

Submission enquiries: bmccancer@biomedcentral.com
General enquiries: ORSupport@springernature.com

BMC Cancer

Contact us