Trends in Costs of Depression in Adults with Diabetes in the United States: Medical Expenditure Panel Survey, 2004-2011
Trends in Costs of Depression in Adults with Diabetes in the United States: Medical Expenditure Panel Survey, 2004-2011
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DOI：
10.1007/s11606-016-3650-1
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发表时间：
2016-06-01
影响因子：
5.7
通讯作者：
Dismuke, Clara E.
中科院分区：
文献类型：
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作者：
Egede, Leonard E.;Walker, Rebekah J.;Dismuke, Clara E.
研究糖尿病患者和四类共病抑郁症（无抑郁症、未识别抑郁症、无症状抑郁症或有症状抑郁症）之一的成年人8年内医疗费用趋势的差异，使用2004-2011年医疗支出小组调查（MEPS）的数据进行全国代表性估计。因变量是日历年的医疗保健总支出，包括办公室、医院门诊、急诊室、住院、处方、牙科和家庭医疗保健支出。2004-2011年的直接医疗费用调整为2014年的共同美元价值。主要自变量是根据ICD-9-CM编码和PHQ-2抑郁筛查工具创建的四个互斥抑郁类别。使用两部分模型估计医疗保健支出，并根据年龄、性别、种族、婚姻状况、教育、健康保险、大都市统计区状况、地区、收入水平和合并症进行调整。（未加权样本为15,548，加权样本为17,465,579），10. 2%的人有未被识别的抑郁症，13. 6%的人有无症状的抑郁症，8. 9%的人有症状的抑郁症。在合并样本中，调整协变量后，未识别抑郁症的增量成本为2872美元（95% CI 1660-4084），无症状抑郁症增加3347美元（95% CI 2568-4386），和症状性抑郁增加了5170美元（CI 95% 3610-6731）。调整后的分析显示，未被识别和无症状的抑郁症患者的支出比无抑郁症患者高2000 -3000美元，症状性抑郁症要高出五千美元随着时间的推移，较高的医疗支出持续存在，只有症状性抑郁症随着时间的推移持续下降。
To investigate differences in healthcare cost trends over 8 years in adults with diabetes and one of four categories of comorbid depression: no depression, unrecognized depression, asymptomatic depression, or symptomatic depression.Data from the 2004-2011 Medical Expenditure Panel Survey (MEPS) was used to create nationally representative estimates. The dependent variable was total healthcare expenditures for the calendar year, including office-based, hospital outpatient, emergency room, inpatient hospital, prescription, dental, and home health care expenditures. The 2004-2011 direct medical costs were adjusted to a common 2014 dollar value. The primary independent variable was four mutually exclusive depression categories created from ICD-9-CM codes and the PHQ-2 depression screening tool. Healthcare expenditures were estimated using a two-part model and were adjusted for age, sex, race, marital status, education, health insurance, metropolitan statistical area status, region, income level, and comorbidities.Based on a national sample of adults with diabetes (unweighted sample of 15,548, weighted sample of 17,465,579), 10.2 % had unrecognized depression, 13.6 % had asymptomatic depression, and 8.9 % had symptomatic depression. In the pooled sample, after adjusting for covariates, the incremental cost of unrecognized depression was $2872 (95 % CI 1660-4084), asymptomatic depression increased by $3347 (95 % CI 2568-4386), and symptomatic depression increased by $5170 (CI 95 % 3610-6731) compared to patients with no depression.Adjusted analyses showed that expenditures were $2000-3000 higher for unrecognized and asymptomatic depression than no depression, and $5000 higher for symptomatic depression. Higher medical expenditures persisted over time, with only symptomatic depression showing a sustained decrease over time.