Case Western Reserve University School of Medicine, Cleveland, Ohio, USA.
University of Michigan, Ann Arbor, Michigan, USA.
Am J Ophthalmol. 2021 Sep;229:184-193. doi: 10.1016/j.ajo.2021.03.062. Epub 2021 Jun 23.
We sought to analyze the incremental economic burden of depression on adults with concurrent ophthalmic conditions in the United States.
Retrospective cross-sectional study.
Using the Medical Expenditure Panel Survey from 2016 to 2018, ophthalmic patients with ≥1 outpatient visit were identified by International Classification of Diseases, 10th revision, Clinical Modification codes and stratified based on the presence of concurrent depression. A multivariate 2-part regression model was used to determine incremental economic burden, health care sector utilization, and expenditures.
Of 7279 ophthalmic patients, 1123 (15.43%) were diagnosed with depression (mean expenditures $17,017.25 ± $2019.13) and 6156 patients (84.57%) without depression (mean expenditures $9924.50 ± $692.94). Patients with depression were more likely to be female, white, lower income, use Medicare/Medicaid, and to have comorbidities (P < .001). These patients faced $5894.86 (95% confidence interval $4222.33-$7348.36, P < .001) in incremental economic expenditures because of depression, resulting in an additional $22.4 billion annually when extrapolating nationally. These patients had higher utilization for all health care service sectors (P < .025 for all) and higher expenditures for outpatient (P = .022) and prescription medications (P = .029) when adjusted for sociodemographic variables and comorbidities. Depression was responsible for 6.9% of inpatient admissions (the second-leading cause) for this cohort of patients.
Ophthalmic patients with depression had a higher incremental economic burden and health care service sector utilization and expenditures. Patients with ophthalmic pathologies, including dry eye syndrome, blindness, and retinopathies, were more likely to be depressed. As psychiatric and ophthalmic conditions may have a bidirectional relationship, exacerbating disease severity and financial burden for patients with both, ophthalmologists may need to be more cognizant of the burden of depression among patients.
我们旨在分析美国合并眼科疾病的成年人抑郁的额外经济负担。
回顾性横截面研究。
使用 2016 年至 2018 年的医疗支出调查，通过国际疾病分类第 10 次修订版临床修正代码识别出≥1 次门诊就诊的眼科患者，并根据是否合并抑郁进行分层。采用多元两部分回归模型来确定额外的经济负担、医疗保健部门的利用和支出。
在 7279 名眼科患者中，有 1123 名（15.43%）被诊断为抑郁症（平均支出为 17017.25 美元±2019.13 美元），6156 名（84.57%）患者没有抑郁症（平均支出为 9924.50 美元±692.94 美元）。患有抑郁症的患者更可能是女性、白人、低收入、使用医疗保险/医疗补助，并且合并症更多（P <.001）。由于抑郁，这些患者额外支出了 5894.86 美元（95%置信区间为 4222.33-7348.36，P <.001），当全国范围内推算时，每年额外增加 224 亿美元。这些患者所有医疗服务部门的利用率都更高（所有部门 P <.025），调整社会人口统计学变量和合并症后，门诊（P =.022）和处方药（P =.029）的支出更高。抑郁是该患者队列中住院治疗的第二大原因（占 6.9%）。
患有抑郁症的眼科患者的额外经济负担以及医疗服务部门的利用和支出更高。患有眼科疾病的患者，包括干眼症、失明和视网膜病变，更有可能患有抑郁症。由于精神和眼科疾病可能存在双向关系，会加重患者的疾病严重程度和经济负担，因此眼科医生可能需要更加意识到患者的抑郁负担。
