抑郁症诊断和抗抑郁治疗对慢性阻塞性肺疾病医疗保险受益人的死亡率的影响。
Effects of depression diagnosis and antidepressant treatment on mortality in Medicare beneficiaries with chronic obstructive pulmonary disease.
机构信息
Department of Pharmacy Care Systems, Harrison School of Pharmacy, Auburn University, Auburn, Alabama 36849, USA.
出版信息
J Am Geriatr Soc. 2013 May;61(5):754-61. doi: 10.1111/jgs.12220. Epub 2013 Apr 25.
OBJECTIVES
To estimate the effects of depression diagnosis and antidepressant treatment on 2-year all-cause mortality in Medicare beneficiaries with chronic obstructive pulmonary disease (COPD) and determine whether Social Security Disability Insurance (SSDI) eligibility modifies these relationships.
DESIGN
Retrospective cohort study.
SETTING
A 5% random sample of Medicare beneficiaries aged 65 and older in stand-alone Part D plans in 2006 to 2008.
PARTICIPANTS
Beneficiaries diagnosed with COPD and continuously enrolled in Medicare Parts A, B, and D (N = 75,699).
MEASUREMENTS
Depression diagnosis was assessed at baseline (2006). Evidence of antidepressant treatment was measured across time. Covariates included baseline characteristics, comorbidities, and disease severity. Survival analyses using Cox proportional hazards models estimated 2-year mortality associated with depression diagnosis or antidepressant treatment (in beneficiaries with depression). Interaction terms of SSDI eligibility with baseline depression and time-dependent antidepressant treatment were tested.
RESULTS
More than one-fifth (21.6%) of beneficiaries with COPD had a depression diagnosis at baseline, and 82.1% of those received antidepressants. Nearly one-sixth (16.3%) of the sample were SSDI eligible. Baseline depression heightened risk of death (hazard ratio = 1.13, 95% confidence interval = 1.09-1.18) in beneficiaries who were not eligible for SSDI. In beneficiaries with depression, the association between antidepressant treatment and lower mortality was different according to SSDI eligibility status.
CONCLUSION
Social Security Disability Insurance eligibility modifies the effects of depression and antidepressant treatment on mortality in Medicare beneficiaries with COPD. These data suggest that clinicians should identify and treat depression in individuals with COPD, but further studies are needed to determine the effect of these interventions.
目的
评估在患有慢性阻塞性肺疾病（COPD）的医疗保险受益人群中，抑郁诊断和抗抑郁治疗对 2 年全因死亡率的影响，并确定社会保障残疾保险（SSDI）资格是否改变这些关系。
设计
回顾性队列研究。
地点
2006 年至 2008 年，在独立的 Medicare 部分 D 计划中，对 65 岁及以上的 Medicare 受益人的 5%随机样本。
参与者
被诊断患有 COPD 并连续参加 Medicare 部分 A、B 和 D 的受益人（N=75699）。
测量方法
在基线（2006 年）评估抑郁诊断。抗抑郁治疗的证据是通过时间测量的。协变量包括基线特征、合并症和疾病严重程度。使用 Cox 比例风险模型的生存分析估计了与抑郁诊断或抗抑郁治疗相关的 2 年死亡率（在患有抑郁的受益人群中）。测试了 SSDI 资格与基线抑郁和时间依赖性抗抑郁治疗的交互项。
结果
超过五分之一（21.6%）的 COPD 患者在基线时患有抑郁诊断，其中 82.1%的患者接受了抗抑郁治疗。样本中近六分之一（16.3%）的人有 SSDI 资格。基线抑郁增加了不符合 SSDI 资格的受益人的死亡风险（风险比=1.13，95%置信区间=1.09-1.18）。在患有抑郁的受益人群中，抗抑郁治疗与较低死亡率之间的关系因 SSDI 资格状况而异。
结论
社会保障残疾保险资格改变了抑郁和抗抑郁治疗对 Medicare 患有 COPD 的受益人群死亡率的影响。这些数据表明，临床医生应该识别和治疗 COPD 患者的抑郁，但需要进一步研究来确定这些干预措施的效果。
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