Depression and Risk of Hospitalizations for Ambulatory Care-Sensitive Conditions in Patients with Diabetes

Abstract

BACKGROUND: Hospitalizations for ambulatory caresensitive conditions (ACSCs), conditions that should not require inpatient treatment if timely and appropriate ambulatory care is provided, may be an important contributor to rising healthcare costs and public health burden. OBJECTIVE: To examine if probable major depression is independently associated with hospitalization for an ACSC in patients with diabetes. DESIGN: Secondary analysis of data from a prospective cohort study. PARTICIPANTS: Population-based cohort of 4,128 patients with diabetes ≥ 18 years old seen in primary care, who were enrolled between 2000 and 2002 and followed for 5 years (through 2007). MAIN MEASURES: Depressive symptoms were assessed with the Patient Health Questionnaire-9. Outcomes of interest included time to initial hospitalization for an ACSC and total number of ACSC-related hospitalizations. We used Cox proportional hazards regression models to ascertain an association between probable major depression and time to ACSC-related hospitalization, as well as Poisson regression for models examining probable major depression and number of ACSC-related hospitalizations. KEY RESULTS: Patients' mean age at study enrollment was 63.4 years (Standard Deviation: 13.4 years). Over the 5-year follow-up period, 981 patients in the study were hospitalized a total of 1,721 times for an ACSC, comprising 45.1 % of all hospitalizations. After adjusting for baseline demographic, clinical and health-risk behavioral factors, probable major depression was associated with initial ACSC-related hospitalization (Hazard Ratio: 1.41, 95 % Confidence Interval [95 % CI]: 1.15, 1.72) and number of ACSC-related hospitalizations (Relative Risk: 1.37, 95 % CI: 1.12, 1.68). CONCLUSIONS: Probable major depression in patients with diabetes is independently associated with hospitalization for an ACSC. Additional research is warranted to ascertain if effective interventions for depression in patients with diabetes could reduce the risk of hospitalizations for ACSCs and their associated adverse outcomes.

Neuropsychiatric Disorders and Potentially Preventable Hospitalizations in a Prospective Cohort Study of Older Americans

“…In addition to neuropsychiatric disorders and other previously identified risk factors such as increased age, 5,11,18 greater medical comorbidity, 5,18 and prior hospitalization, 5,18 we found that lower household net worth at baseline, an indicator of lower socioeconomic status, was independently associated with both increased risk of hospitalization for an ACSC as well as 30-day rehospitalization. These findings expand upon prior work that has identified lower socioeconomic status as a potential risk factor for potentially preventable hospitalizations and rehospitalizations.…”

“…5,7,10,11,[14][15][16][17][18] Data on demographics (e.g., age, sex, race, education, marital/partnered status, and household net worth), alcohol use, and smoking came from the baseline HRS interview.…”

“…The few prior studies examining the contribution of depression or dementia to the risk of these outcomes have been limited to single-centers, 15,16 geographically defined health systems, 17,18 or specific chronic disease populations. 18 Furthermore, while depression is frequently comorbid with mild cognitive impairment and dementia, 19 no study to date has considered the impact of comorbidity between depression and dementia on the risk of preventable hospitalizations and/or rehospitalizations.…”

Capsule Commentary on Davydow et al., Depression and Risk of Hospitalizations for Ambulatory Care-Sensitive Conditions in Patients with Diabetes

“…In this issue of JGIM, Davydow and colleagues 2 analyzed prospective cohort data in a large sample of patients (N=4,128) with diabetes seen in 9 Group Health Cooperative primary care clinics in the Seattle area. The primary study question was whether comorbid major depression was independently associated with hospitalizations for ambulatory care-sensitive conditions (ACSCs) in patients with diabetes.…”

Getting Back to Basics

“…3 And a provocative study by Davydow et al suggests that inadequately treated major depression is a major risk factor for hospitalization for ambulatory-sensitive conditions. 4 A Capsule Commentary by JGIM Deputy Editor Matt Bair puts the findings in context. 5 It is accepted wisdom in the business world that execution beats strategy six days out of seven.…”