School of Nursing, West Virginia University, Morgantown 26506, USA.
School of Pharmacy, West Virginia University, Morgantown, 26506 WV, USA.
J Diabetes Res. 2018 Oct 24;2018:4842520. doi: 10.1155/2018/4842520. eCollection 2018.
We conducted a retrospective cross-sectional study to estimate the humanistic and economic burden associated with depression and anxiety among adults with comorbid diabetes and hypertension. Pooled data from the 2013 and 2015 Medical Expenditure Panel Survey were used to include adults (≥18 years old) who were alive and diagnosed with both diabetes and hypertension during the observation period. We assessed the humanistic burden with health-related quality of life (HRQoL) and economic burden with the total annual healthcare expenditures. Depending on the presence/absence of depression and anxiety, the study sample was divided into four groups (i.e., no depression/anxiety, depression only, anxiety only, and depression and anxiety). Multivariable regression analyses were used to evaluate the associations between the depression/anxiety categories and disease burden measures. The incremental burden associated with depression and/or anxiety was estimated with the counterfactual recycled prediction. Of the 4560 adults with comorbid diabetes and hypertension, 13.2% reported depression only, 8.7% reported anxiety only, and 7.7% reported both. Results from adjusted analyses indicated that the presence/absence of depression and anxiety was associated with significantly poorer HRQoL, especially on the mental component. Having either depression or anxiety corresponded to reduced mental component summary scores by more than four points. The reduction was as high as 10.35 points when both conditions occurred. Comparing to adults without depression or anxiety, the per-capital incremental annual healthcare expenditures were $4607 for the depression group, $2481 for the anxiety group, and $8709 for adults with both conditions. Furthermore, adults with depression and anxiety were 58% more likely to spend at least 10% of annual household income on healthcare as compared to those with neither the conditions. Our results highlight the needs for integrating cost-effective mental health services into diabetes management to improve the HRQoL and reduce healthcare costs for adults with comorbid diabetes and hypertension.
我们进行了一项回顾性的横断面研究，以估计患有糖尿病和高血压合并症的成年人中抑郁和焦虑相关的人文和经济负担。使用 2013 年和 2015 年医疗支出调查的汇总数据，纳入在观察期内存活且被诊断患有糖尿病和高血压的成年人（≥18 岁）。我们使用健康相关生活质量（HRQoL）评估人文负担，使用总年度医疗保健支出评估经济负担。根据是否存在抑郁和焦虑，研究样本分为四组（即无抑郁/焦虑、仅抑郁、仅焦虑和抑郁和焦虑）。多变量回归分析用于评估抑郁/焦虑类别与疾病负担测量之间的关联。使用反事实循环预测估计与抑郁和/或焦虑相关的增量负担。在 4560 名患有糖尿病和高血压合并症的成年人中，13.2%报告仅患有抑郁，8.7%报告仅患有焦虑，7.7%报告同时患有这两种疾病。调整后的分析结果表明，抑郁和焦虑的存在与否与 HRQoL 显著恶化相关，尤其是在精神成分方面。存在抑郁或焦虑与精神成分综合评分降低超过 4 分相对应。当两种情况同时发生时，降低幅度高达 10.35 分。与没有抑郁或焦虑的成年人相比，患有抑郁的成年人的人均年度医疗保健支出增加了 4607 美元，患有焦虑的成年人的人均年度医疗保健支出增加了 2481 美元，而同时患有两种疾病的成年人的人均年度医疗保健支出增加了 8709 美元。此外，与没有这两种疾病的成年人相比，患有抑郁和焦虑的成年人有 58%的可能性至少花费 10%的家庭年收入用于医疗保健。我们的研究结果强调了将具有成本效益的心理健康服务纳入糖尿病管理的必要性，以提高患有糖尿病和高血压合并症的成年人的 HRQoL 并降低医疗保健成本。
