Department of Rheumatology, Park Nicollet Clinic and HealthPartners Institute, HealthPartners Inc, Bloomington, Minnesota.
Division of Health Policy and Management, University of Minnesota, Minneapolis, Minnesota.
J Am Geriatr Soc. 2019 Aug;67(8):1596-1603. doi: 10.1111/jgs.15881. Epub 2019 Mar 23.
Depressive symptoms can be both a cause and a consequence of functional limitations and medical conditions. Our objectives were to determine the association of depressive symptoms with subsequent total healthcare costs in older women after accounting for functional limitations and multimorbidity.
Prospective cohort study (Study of Osteoporotic Fractures [SOF]).
Four US sites.
A total of 2508 community-dwelling women (mean age = 79.4 years) participating in the SOF year 10 (Y10) examination linked with their Medicare claims data.
At Y10, depressive symptoms were measured using the 15-item Geriatric Depression Scale (GDS) and functional limitations were assessed by number (range = 0-5) of impairments in performing instrumental activities of daily living. Multimorbidity was ascertained by the Elixhauser method using claims data for the 12 months preceding the Y10 examination. Total direct healthcare costs, outpatient costs, acute hospital stays, and skilled nursing facility during the 12 months following the Y10 examination were ascertained from claims data.
Annualized mean (SD) total healthcare costs were $4654 ($9075) in those with little or no depressive symptoms (GDS score = 0-1), $7871 ($14 534) in those with mild depressive symptoms (GDS score = 2-5), and $9010 ($15 578) in those with moderate to severe depressive symptoms (GDS score = 6 or more). After adjustment for age, site, self-reported functional limitations, and multimorbidity, the magnitudes of these incremental costs were partially attenuated (cost ratio = 1.34 [95% confidence interval {CI} = 1.14-1.59] for those with mild depressive symptoms, and cost ratio = 1.29 [95% CI = 0.99-1.69] for those with moderate to severe depressive symptoms vs women with little or no depressive symptoms).
Depressive symptoms were associated with higher subsequent healthcare costs attributable, in part, to greater functional limitations and multimorbidity among those with symptoms. Importantly, even mild depressive symptoms were associated with higher healthcare costs. J Am Geriatr Soc 67:1596-1603, 2019.
抑郁症状既可以是功能障碍和医疗状况的原因，也可以是其后果。我们的目的是确定在考虑到功能障碍和多种合并症后，抑郁症状与老年女性随后的总医疗保健成本之间的关系。
前瞻性队列研究（骨质疏松性骨折研究[SOF]）。
美国四个地点。
共有 2508 名居住在社区的女性（平均年龄=79.4 岁）参加了 SOF 第 10 年（Y10）检查，并与她们的医疗保险索赔数据相关联。
在 Y10 时，使用 15 项老年抑郁量表（GDS）测量抑郁症状，通过进行日常活动的工具性活动的障碍数量（范围=0-5）来评估功能障碍。使用在 Y10 检查前的 12 个月的索赔数据，通过 Elixhauser 方法确定多种合并症。在 Y10 检查后的 12 个月内，从索赔数据中确定总直接医疗保健费用、门诊费用、急性住院和熟练护理设施的费用。
在没有或几乎没有抑郁症状（GDS 评分=0-1）的患者中，年化平均（SD）总医疗保健费用为 4654 美元（9075 美元）；在有轻度抑郁症状（GDS 评分=2-5）的患者中为 7871 美元（14534 美元）；在有中度至重度抑郁症状（GDS 评分=6 或更高）的患者中为 9010 美元（15578 美元）。在调整年龄、地点、自我报告的功能障碍和多种合并症后，这些增量成本的幅度有所降低（与无或几乎无抑郁症状的女性相比，轻度抑郁症状患者的成本比为 1.34（95%置信区间[CI]：1.14-1.59），中度至重度抑郁症状患者的成本比为 1.29（95%CI：0.99-1.69））。
抑郁症状与较高的后续医疗保健费用相关，部分原因是有症状患者的功能障碍和多种合并症更为严重。重要的是，即使是轻度抑郁症状也与更高的医疗保健费用相关。美国老年医学会 67:1596-1603，2019 年。
