Incidence and Risk Factors of Suicide in Patients With Esophageal Cancer: A Population‐Based Analysis Using the SEER Database

BACKGROUND: The suicide mortality among patients with esophageal cancer is significantly higher than that in the general population and among patients with other cancers. This study aims to analyze the suicide mortality and its risk factors in the esophageal cancer population in the United States, and to develop a clinically applicable predictive model. This model is intended to assist in the early identification of esophageal cancer patients at higher risk of suicide in clinical practice, thereby providing a basis for implementing targeted interventions. METHODS: The Surveillance, Epidemiology, and End Results (SEER) database was used to identify 81,038 esophageal cancer patients diagnosed between 2000 and 2022 to calculate the standardized mortality ratio (SMR). Risk factors for suicide death were analyzed using univariate and multivariate Cox proportional hazards models. Additionally, a nomogram model was employed to estimate the probability of suicide. RESULTS: Compared to the contemporaneous general US population (with a suicide rate of 12.49 per 100,000 person-years), follow-up of 81,038 esophageal cancer patients (2000-2022) revealed a higher suicide rate of 106.52 per 100,000 person-years. The standardized mortality ratio (SMR) was 8.53 (95% CI: 7.31-9.89). Older age at diagnosis was associated with increased suicide risk (< 60 vs. 60-70: aHR = 1.565, 95% CI: 1.036-2.364, p < 0.05; < 60 vs. > 70: aHR = 2.29, 95% CI: 1.462-3.588, p < 0.001). Males had a significantly higher risk than females (aHR = 15.548, 95% CI: 5.736-42.145, p < 0.001). White and other racial groups had a substantially higher suicide risk compared to the Black group (Black vs. White: aHR = 17.551, 95% CI: 2.451-125.675, p = 0.004; Black vs. Other/Unknown: aHR = 18.273, 95% CI: 2.353-141.891, p = 0.005). Unmarried patients exhibited higher risk than married patients (aHR = 2.151, 95% CI: 1.455-3.18, p < 0.001). Patients who underwent surgery had a lower risk than those who did not (aHR = 1.881, 95% CI: 1.319-2.682, p < 0.001). CONCLUSION: Esophageal cancer patients face a significantly higher risk of suicide compared to the general population, with key risk factors including advanced age, male sex, non-Black race, unmarried or single status, and not having received surgical treatment. To address this, the present study developed a personalized suicide risk quantification nomogram specifically for esophageal cancer patients. This tool aims to assist clinicians in effectively identifying high-risk individuals and providing them with timely and appropriate psychological support interventions.