Johns Hopkins University, Baltimore, Maryland.
University of Washington, Seattle.
Arthritis Care Res (Hoboken). 2019 Jun;71(6):748-757. doi: 10.1002/acr.23695. Epub 2019 May 10.
To examine independent and combined effects of pain with concurrent insomnia and depression symptoms on the use of health care services in older adults with osteoarthritis (OA).
Patients were Group Health Cooperative (GHC) patients with a primary diagnosis of OA (n = 2,976). We used survey data on pain (Graded Chronic Pain Scale), insomnia (Insomnia Severity Index), and depression (Patient Health Questionnaire-8), and health care use extracted from GHC electronic health records (office visits, length of stay, outpatient and inpatient costs, and hip or knee replacement) for 3 years after the survey. Negative binomial, logistic, and generalized linear models were used to assess predictors of health care use.
Approximately 34% and 29% of patients displayed at least subclinical insomnia and at least subclinical depression symptoms, respectively, in addition to moderate-to-severe pain. Pain had the greatest independent effects on increasing all types of health care use, followed by depression (moderate effects) on increased office visits, length of stay, outpatient and inpatient costs, and insomnia (mild effects) on decreased length of stay. No synergistic effects of the 3 symptoms on use of health care services were observed. The combined effects of pain plus insomnia and pain plus depression were significant for all types of health care use and increased greatly with increasing severity of insomnia and depression, except for hip/knee replacement.
Pain is the main driver for health care use in patients with OA. In addition to pain, insomnia plus depression jointly increased diverse types of health care use, and these combined effects increased greatly with increasing severity of insomnia and depression. These findings indicate the important role that concurrent symptomatic conditions may play in increasing use of health care services.
探讨伴有并存性失眠和抑郁症状的疼痛对老年骨关节炎（OA）患者医疗服务利用的独立和联合影响。
患者为 Group Health Cooperative（GHC）的 OA 初诊患者（n=2976）。我们使用了来自 GHC 电子健康记录的关于疼痛（慢性疼痛分级量表）、失眠（失眠严重程度指数）和抑郁（患者健康问卷-8）的调查数据以及 3 年后的医疗保健使用情况（门诊就诊、住院时间、门诊和住院费用、髋关节或膝关节置换）。使用负二项式、逻辑回归和广义线性模型来评估医疗保健使用的预测因素。
约 34%和 29%的患者分别存在至少亚临床失眠和至少亚临床抑郁症状，同时伴有中重度疼痛。疼痛对增加所有类型的医疗保健使用的独立影响最大，其次是抑郁（中度影响）对增加门诊就诊、住院时间、门诊和住院费用的影响，以及失眠（轻度影响）对降低住院时间的影响。未观察到 3 种症状对医疗服务使用的协同效应。疼痛加失眠和疼痛加抑郁的联合效应在所有类型的医疗保健使用中均显著，且随着失眠和抑郁严重程度的增加而大大增加，髋关节/膝关节置换除外。
疼痛是 OA 患者医疗保健使用的主要驱动因素。除疼痛外，失眠加抑郁共同增加了多种类型的医疗保健使用，且这些联合效应随着失眠和抑郁严重程度的增加而大大增加。这些发现表明并存症状可能在增加医疗服务使用方面发挥重要作用。
