Abstract：
To analyze potential racial disparities in the diagnosis and management of depression associated with androgen deprivation therapy.
TriNetX health record network was queried for prostate cancer patients treated with androgen deprivation therapy from 2003-2023. Differences in rates of depression diagnosis and treatment were compared between White and Black patients. Means, odds ratios, and t tests were calculated in univariate analysis with 95% confidence intervals (CI).
Data were queried from 93 health care organizations to yield 78,313 prostate cancer patients treated with androgen deprivation therapy. Patients on androgen deprivation therapy had 60% greater odds of developing depression vs other patients [9% vs 6%; odds ratio (OR) 1.6; 95% CI (1.5-1.7); P <.0001]. Of those with depression secondary to androgen deprivation therapy, only 35% were treated with antidepressants. After starting androgen deprivation therapy, White patients had 30% greater odds of being diagnosed with depression, compared to Black patients [10% vs 8%; OR 1.3; 95% CI (1.2-1.4); P <.001]. White patients also had higher odds of being treated with a first line antidepressant than Black patients [56% vs 48%; OR 1.4, 95% CI (1.2-1.6), P <.001].
This analysis confirms a significant association between androgen deprivation therapy and the development of clinical depression, and highlights its medical undertreatment. Importantly, our findings also indicate significant racial disparities in the identification and treatment of depression. Routine screening initiatives that account for social determinants of health may alleviate this disparity. Limitations of this study include retrospective design and lack of data describing severity of depression, which might correlate with need for medication.
TriNetX health record network was queried for prostate cancer patients treated with androgen deprivation therapy from 2003-2023. Differences in rates of depression diagnosis and treatment were compared between White and Black patients. Means, odds ratios, and t tests were calculated in univariate analysis with 95% confidence intervals (CI).
Data were queried from 93 health care organizations to yield 78,313 prostate cancer patients treated with androgen deprivation therapy. Patients on androgen deprivation therapy had 60% greater odds of developing depression vs other patients [9% vs 6%; odds ratio (OR) 1.6; 95% CI (1.5-1.7); P <.0001]. Of those with depression secondary to androgen deprivation therapy, only 35% were treated with antidepressants. After starting androgen deprivation therapy, White patients had 30% greater odds of being diagnosed with depression, compared to Black patients [10% vs 8%; OR 1.3; 95% CI (1.2-1.4); P <.001]. White patients also had higher odds of being treated with a first line antidepressant than Black patients [56% vs 48%; OR 1.4, 95% CI (1.2-1.6), P <.001].
This analysis confirms a significant association between androgen deprivation therapy and the development of clinical depression, and highlights its medical undertreatment. Importantly, our findings also indicate significant racial disparities in the identification and treatment of depression. Routine screening initiatives that account for social determinants of health may alleviate this disparity. Limitations of this study include retrospective design and lack of data describing severity of depression, which might correlate with need for medication.
摘要：
目的：分析与雄激素剥夺治疗相关的抑郁症的诊断和治疗中潜在的种族差异。
方法：TriNetX健康记录网络查询了2003-2023年接受雄激素剥夺治疗的前列腺癌患者。比较了白人和黑人患者抑郁症诊断和治疗率的差异。意味着，赔率比,t检验在单变量分析中计算，置信区间为95%。
结果：从93个医疗机构查询数据，得到78,313名接受雄激素剥夺治疗的前列腺癌患者。与其他患者相比，接受雄激素剥夺治疗的患者患抑郁症的几率高60％[9％vs6％;OR1.6;95％CI（1.5-1.7）;p<0.0001]。在雄激素剥夺治疗继发的抑郁症患者中，只有35%的患者接受了抗抑郁药治疗.开始雄激素剥夺治疗后，白人患者被诊断为抑郁症的几率要高出30%，与Black患者相比[10%vs8%；OR1.3；95%CI(1.2-1.4)；p<0.001]。与Black患者相比，白人患者接受一线抗抑郁药治疗的几率也更高[56％vs48％；OR1.4，95％CI（1.2-1.6），p<0.001]。
结论：该分析证实了雄激素剥夺治疗与临床抑郁症的发展之间的显着关联，并强调了其医学治疗不足。重要的是,我们的发现还表明,在抑郁症的识别和治疗方面存在显著的种族差异.考虑到健康的社会决定因素的常规筛查举措可能会减轻这种差距。这项研究的局限性包括回顾性设计和缺乏描述抑郁症严重程度的数据，这可能与药物需求有关。
方法：TriNetX健康记录网络查询了2003-2023年接受雄激素剥夺治疗的前列腺癌患者。比较了白人和黑人患者抑郁症诊断和治疗率的差异。意味着，赔率比,t检验在单变量分析中计算，置信区间为95%。
结果：从93个医疗机构查询数据，得到78,313名接受雄激素剥夺治疗的前列腺癌患者。与其他患者相比，接受雄激素剥夺治疗的患者患抑郁症的几率高60％[9％vs6％;OR1.6;95％CI（1.5-1.7）;p<0.0001]。在雄激素剥夺治疗继发的抑郁症患者中，只有35%的患者接受了抗抑郁药治疗.开始雄激素剥夺治疗后，白人患者被诊断为抑郁症的几率要高出30%，与Black患者相比[10%vs8%；OR1.3；95%CI(1.2-1.4)；p<0.001]。与Black患者相比，白人患者接受一线抗抑郁药治疗的几率也更高[56％vs48％；OR1.4，95％CI（1.2-1.6），p<0.001]。
结论：该分析证实了雄激素剥夺治疗与临床抑郁症的发展之间的显着关联，并强调了其医学治疗不足。重要的是,我们的发现还表明,在抑郁症的识别和治疗方面存在显著的种族差异.考虑到健康的社会决定因素的常规筛查举措可能会减轻这种差距。这项研究的局限性包括回顾性设计和缺乏描述抑郁症严重程度的数据，这可能与药物需求有关。
