Effects of Osteoarthritis Pain and Concurrent Insomnia and Depression on Health Care Use in a Primary Care Population of Older Adults.
Effects of Osteoarthritis Pain and Concurrent Insomnia and Depression on Health Care Use in a Primary Care Population of Older Adults.
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DOI：
10.1002/acr.23695
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发表时间：
2019-06
影响因子：
4.7
通讯作者：
Von Korff M
中科院分区：
文献类型：
--
作者：
Liu M;McCurry SM;Belza B;Dobra A;Buchanan DT;Vitiello MV;Von Korff M
在患有骨关节炎（OA）的老年人中，检查疼痛伴失眠和抑郁症状对医疗保健使用（HCU）的独立和联合影响。参与者是初步诊断为OA的团体健康合作组织（GHC）患者（N = 2，976）。我们使用了关于疼痛（分级慢性疼痛量表）、失眠（失眠严重程度指数）和抑郁（患者健康问卷-8）的调查数据，以及从GHC电子健康记录中提取的HCU（门诊访视、住院时间[LOS]、门诊和住院费用以及髋关节/膝关节置换术）。采用负二项、逻辑和广义线性模型评估HCU预测因子。大约34%和29%的参与者分别表现出至少亚临床失眠和至少亚临床抑郁症状，以及中度至重度疼痛。疼痛对增加所有类型的HCU有最大的独立影响，其次是抑郁症（中度影响）增加办公室访问，LOS，门诊和住院费用，失眠（轻度影响）减少LOS。三种症状对HCU无协同作用。疼痛+失眠和疼痛+抑郁的联合效应对于所有类型的HCU都是显著的，并且随着失眠和抑郁严重程度的增加而大大增加，除了髋关节/膝关节置换术。疼痛是OA患者HCU的主要驱动因素。失眠和抑郁共同增加了各种类型的HCU，除了疼痛，这些联合作用大大增加了失眠和抑郁的严重程度。这些发现表明并发症状性疾病可能在增加HCU中发挥重要作用。
To examine independent and combined effects of pain with concurrent insomnia and depression symptoms on health care use (HCU) in older adults with osteoarthritis (OA). Participants were Group Health Cooperative (GHC) patients with a primary diagnosis of OA (N = 2,976). We used survey data on pain (Graded Chronic Pain Scale), insomnia (Insomnia Severity Index), and depression (Patient Health Questionnaire-8), and HCU extracted from GHC electronic health records (office visits, length of stay [LOS], outpatient and inpatient costs, and hip/knee replacement) for three years after the survey. Negative binomial, logistic, and generalized linear models were employed to assess HCU predictors. About 34% and 29% of participants presented at least sub-clinical insomnia and at least sub-clinical depression symptoms, respectively, in addition to moderate to severe pain. Pain had the largest independent effects on increasing all types of HCU, followed by depression (moderate effects) on increased office visits, LOS, outpatient and inpatient costs, and insomnia (mild effects) on decreased LOS. No synergistic effects were found on HCU among the three symptoms. Combined effects of pain + insomnia, and pain + depression were significant for all types of HCU and increased greatly with increasing insomnia and depression severity except for hip/knee replacement. Pain is the main driver for HCU in OA. Insomnia and depression jointly increased diverse types of HCU in addition to pain and these combined effects increased greatly with increasing insomnia and depression severity. These findings indicate the important role that concurrent symptomatic conditions may play in increasing HCU.
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