Diabetes, minor depression and health care utilization and expenditures: a retrospective database study.
Diabetes, minor depression and health care utilization and expenditures: a retrospective database study.
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DOI：
10.1186/1478-7547-5-4
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发表时间：
2007-04-18
期刊：
影响因子：
--
通讯作者：
McCollum M
中科院分区：
文献类型：
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作者：
Nichols L;Barton PL;Glazner J;McCollum M
评估美国成年糖尿病患者中轻度抑郁症的患病率、医疗保健资源利用率以及糖尿病伴和不伴轻度抑郁症患者的支出。在2003年医疗支出小组调查的成年受访者中，糖尿病是通过诊断代码和自我报告确定的。通过诊断代码加≥ 1种抗抑郁药处方确定抑郁症。在糖尿病患者和普通人群中估计患抑郁症的几率，并根据社会人口统计学变量（例如，年龄、性别、种族/民族）。多变量回归分析评估了与门诊护理、住院、急诊和处方的利用率和对数转换支出相关的因素。2003年，1932名受访者患有糖尿病，435/1932患有糖尿病和轻度抑郁症。成年糖尿病患者比普通人群更容易患抑郁症（调整后OR 1.81，95% CI 1.56，2.09）。糖尿病伴抑郁症患者与不伴抑郁症患者相比，更可能是女性，收入和健康状况较低，糖尿病并发症较多（所有p < 0.05）。在未校正的分析中，患有抑郁症的患者的门诊就诊率高于不患有抑郁症的患者（17.9 vs. 11.4，p = 0.04），处方率也是如此（60.7 vs. 38.1，p = 0.05）。在调整后的分析中，抑郁症与任何类别的资源使用增加或支出增加无关。合并症数量的增加与所有类别的资源使用增加以及门诊护理和处方的支出增加有关。糖尿病患者患抑郁症的可能性是普通人群的两倍。抑郁症的筛查和治疗是必要的，对糖尿病和抑郁症之间的因果关系进行额外的研究也是必要的。
To estimate the prevalence of minor depression among US adults with diabetes, health care resource utilization, and expenditures by people with diabetes with and without minor depression. Among adult 2003 Medical Expenditure Panel Survey respondents, diabetes was identified by diagnosis code and self-report. Depression was identified by diagnosis code plus ≥ one antidepressant prescription. Odds of having depression was estimated in people with diabetes and the general population, adjusted for sociodemographic variables (e.g., age, sex, race/ethnicity). Multivariate regressions evaluated factors associated with utilization and log-transformed expenditures for ambulatory care, hospitalizations, emergency visits, and prescriptions. In 2003, 1932 respondents had diabetes, 435/1932 had diabetes and minor depression. Adults with diabetes were more likely than the general population to have depression (adjusted OR 1.81, 95% CI 1.56, 2.09). People with diabetes with versus without comorbid depression were more likely to be women, have lower incomes and health status, and more diabetes complications (all p < 0.05). In unadjusted analyses, ambulatory care visits were higher for those with versus without depression (17.9 vs. 11.4, p = 0.04), as were prescriptions (60.7 vs. 38.1, p = 0.05). In adjusted analyses, depression was not associated with increased resource use or higher expenditures in any category. Increased number of comorbid conditions was associated with increased resource use in all categories, and increased expenditures for ambulatory care and prescriptions. People with diabetes are twice as likely to have depression as the general population. Screening for and treatment of depression is warranted, as is additional research into a causal relationship between diabetes and depression.