Sex-Related Disparities in the Prevalence of Depression among Patients Hospitalized with Type 2 Diabetes Mellitus in Spain, 2011–2020

Abstract

(1) Background: Recent reports suggest a decrease in the prevalence of depression among people with diabetes and important sex-differences in the association between these conditions, however data from Spain is sparse. We aim to assess trends in the prevalence of depression and in-hospital outcomes among patients with type 2 diabetes (T2DM) hospitalized (2011–2020) identifying sex-differences. (2) Methods: Using the Spanish national hospital discharge database we analysed the prevalence of depression globally, by sex, and according to the conditions included in the Charlson comorbidity index (CCI). We tested factors associated with the presence of depression and with in-hospital mortality (IHM). Time trends in the prevalence of depression and variables independently associated with IHM were analyzed using multivariable logistic regression. (3) Results: From 2011 to 2020, we identified 5,971,917 hospitalizations of patients with T2DM (5.7% involved depression). The prevalence of depression decreased significantly between 2011 and 2020. The adjusted prevalence of depression was 3.32-fold higher in women than in men (OR 3.32; 95%CI 3.3–3.35). The highest prevalence of depression among men and women with T2DM was found among those who also had a diagnosis of obesity, liver disease, and COPD. Older age, higher CCI, pneumonia, and having been hospitalized in 2020 increased the risk of IHM in patients with T2DM and depression. Obesity was a protective factor for IHM in both sexes, with no differences detected for IHM between men and women. Among patients hospitalized with T2DM, concomitant depression was associated with lower IHM than among patients without depression (depression paradox). (4) Conclusion: The prevalence of depression decreased over time in both sexes. The prevalence of depression was over three-fold higher in women. Female sex and depression were not associated with higher IHM. Based on our results we recommend that clinicians screen regularly for depression in patients with T2DM, particularly women, younger patients, and those with multiple comorbidities.

Sex differences in the association between diabetes and depressive symptoms: findings from Mexican National Health and Nutrition Survey 2018–2019

“…A study conducted in Germany showed a higher prevalence of DS in women with diabetes (18.8%) than in men with diabetes (13.6%) 30. Similarly, researchers in Spain reported that the prevalence of depression was 3.32 higher in women with diabetes than in men 13. We extended these observations by analysing the interaction between sex and diabetes on the odds of having DS and showing how the clinical burden of diabetes affected men and women living with diabetes.…”

“…Differences by sex have been reported in the prevalence of DS, usually markedly higher among women compared with men 5 6. This disparity is also found in people with diabetes, where the prevalence of having a diagnosis of depression is higher among women than in their male counterparts 12 13. Although some studies have focused on the comorbidity of diabetes and depression,1 14–17 most have not tested for sex differences,18 and the relationship between diabetes and DS from a sex-informed approach, remains an understudied phenomenon 15…”