Incident depression among Medicare beneficiaries with disabilities and HIV.
Incident depression among Medicare beneficiaries with disabilities and HIV.
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DOI：
10.1097/qad.0000000000003268
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发表时间：
2022-07-15
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尽管残疾人中艾滋病毒和抑郁症的患病率异常高，但尚未公布有关残疾医疗保险受益人抑郁症发病率及其相关性的数据。我们评估了艾滋病毒感染对该人群抑郁症的影响。我们使用符合残疾保险资格的 Medicare 受益人的 5% 样本进行了一项回顾性匹配队列研究（1996-2015 年）。感染艾滋病毒（n = 2438）和流行（n = 5758）艾滋病毒的受益人与未感染艾滋病毒的受益人（艾滋病毒-，n = 20778）进行单独匹配。使用以死亡作为竞争风险的细灰色模型来评估艾滋病毒状况、年龄和队列时期对按性别阶层发展为抑郁症的影响。感染艾滋病毒的受益人在五年内患抑郁症的风险较高（p<0.0001）。观察到性别差异（p<0.0001），与对照组相比，男性 HIV 感染者的次分布风险比 (sHR) 更高。该风险随着年龄的增长而降低（p<0.0001），并且近年来有所增加（p<0.0001）。男性中存在显着的年龄-HIV (p=0.004) 和时期-HIV (p=0.006) 交互作用，但女性中则没有。在随访的第一年，男性的 sHR 也更高，尤其是那些感染艾滋病毒的男性。与未感染艾滋病毒的人相比，患有残疾和艾滋病毒的医疗保险参保者患抑郁症的风险更高，尤其是男性和在艾滋病毒诊断的第一年内。艾滋病毒与抑郁症的关联因性别、年龄和队列时期而异。我们的研究结果可能有助于指导这一弱势群体亚群体的抑郁症筛查和综合管理。
Despite disproportionally high prevalence of HIV and depression in persons with disabilities, no data have been published on the incidence and correlates of depression in Medicare beneficiaries with disabilities. We assessed the effect of HIV infection on developing depression in this population. We conducted a retrospective matched cohort study using a 5% sample of Medicare beneficiaries who qualified for disability coverage (1996–2015). Beneficiaries with incident (n=2438) and prevalent (n=5758) HIV were individually matched with beneficiaries without HIV (HIV−, n=20778). Fine-Gray models with death as a competing risk were used to assess the effect of HIV status, age, and cohort period on developing depression by sex strata. Beneficiaries with HIV had a higher risk of developing depression within five years (p<0.0001). Sex differences were observed (p<0.0001), with higher subdistribution hazard ratios (sHR) in males with HIV compared to controls. The risk decreased with age (p<0.0001) and increased in recent years (p<0.0001). There were significant age-HIV (p=0.004) and period-HIV (p=0.006) interactions among males, but not females. The sHR was also higher within the first year of follow up among males, especially those with incident HIV. Medicare enrollees with disabilities and HIV had an increased risk of developing depression compared to those without HIV, especially among males and within the first year of HIV diagnosis. The HIV-depression association varied by sex, age, and cohort period. Our findings may help guide screening and comprehensive management of depression among subgroups in this vulnerable population.