Date of Award

January 2020

Document Type

Open Access Thesis

Degree Name

Master of Public Health (MPH)


School of Public Health

First Advisor

Amy J. Davidoff



Objective: Disparities in self-reported emotional distress and subsequent pharmacologic treatment for emotional distress are not well understood among older adults with cancer. The main objective of this study is to understand racial and ethnic disparities in emotional distress medication and the relationship between self-reported levels of emotional distress. We hypothesize that as self-reported levels of emotional distress increase in severity, the race and ethnic disparities in emotional distress medication will diminish or decrease. Our secondary aim was to understand the role of socioeconomic factors on racial and ethnic disparities in medication use.

Methods: In this retrospective cohort study, we used the SEER-MHOS (2007-2012) database linked to Medicare Part D enrollment and claims. The main outcome was receipt of any emotional distress medication 90 days post-MHOS. Bivariate sample proportions and multivariate logistic regression were used to illustrate differences in receipt of emotional distress medication among key categories and race/ ethnicity. The three models of emotional distress we investigated were: self-reported depression in the past year, functional limitations, and emotional well-being. Results are reported in odds ratios and predicted margins.

Results: A total of 8,889 beneficiaries were included in our study and 28.7% of our sample received medication treatment for emotional distress. There was a significant association between all levels of emotional distress and race/ ethnicity. Half of those reporting depression in the past year (50%) and nearly half of those with severe functional limitations (47%) and poor emotional well-being (56%) received emotional distress medication. After adjusting for all covariates, racial and ethnic minorities had decreased odds of receiving medication for emotional distress compared to non-Hispanic whites. This pattern persisted for non-Hispanic Blacks even when limiting to those experiencing high levels of emotional distress. Non-Hispanic Blacks reporting depression in the past year (AOR=0.36), severe functional limitations (AOR=0.32), and poor emotional well-being (AOR=0.24) had decreased odds of receiving emotional distress medication compared to non-Hispanic whites (p<0.001).

Conclusion: Emotional distress may be undertreated among older adults with cancer, and especially for certain racial and ethnic minorities who self-report depression, functional limitations, and poor emotional well-being. Further research is needed to understand whether low levels of medication use among certain race and ethnic groups are due to utilization of other forms of emotional distress treatment such as therapy or strong social support networks.


This is an Open Access Thesis.

Open Access

This Article is Open Access