Armbrecht Eric, Shah Ruchit, Poorman Gregory W, Luo Linlin, Stephens Jennifer M, Li Benjamin, Pappadopulos Elizabeth, Haider Seema, McIntyre Roger S
Saint Louis University Center for Health Outcomes Research, Saint Louis University, Saint Louis, MO, USA.
Pharmerit International, Bethesda, MD, USA.
J Multidiscip Healthc. 2021 Apr 23;14:887-896. doi: 10.2147/JMDH.S280200. eCollection 2021.
Patients with both major depressive disorder (MDD) and generalized anxiety disorder (GAD) in addition to one or multiple comorbid non-communicable chronic diseases (NCCDs) face unique challenges. However, few studies have characterized how the burden of co-occurring MDD and GAD differs from that of only MDD or only GAD among patients with NCCDs.
In this study, we used Medical Expenditures Panel Survey data from 2010-2017 to understand how the economic and humanistic burden of co-occurring MDD and GAD differs from that of MDD or GAD alone among patients with NCCDs. We used generalized linear models to investigate this relationship and controlled for patient sociodemographics and clinical characteristics.
Co-occurring MDD and GAD was associated with increases in mean annual per patient inpatient visits, office visits, emergency department visits, annual drug costs, and total medical costs. Among patients with 3+ NCCDs, MDD or GAD only was associated with lower odds ratios (ORs) of limitations in activities of daily living (ADLs; 0.532 and 0.508, respectively) and social (0.503, 0.526) and physical limitations (0.613, 0.613) compared to co-occurring MDD and GAD. Compared to patients with co-occurring MDD and GAD, having MDD only or GAD only was associated with significantly lower odds of cognitive limitations (0.659 and 0.461, respectively) in patients with 1-2 NCCDs and patients with 3+ NCCDs (0.511, 0.416).
Comorbid MDD and GAD was associated with higher economic burden, lower quality of life, and greater limitations in daily living compared to MDD or GAD alone. Health-related economic and humanistic burden increased with number of NCCDs.
患有重度抑郁症（MDD）和广泛性焦虑症（GAD）且伴有一种或多种共病的非传染性慢性病（NCCD）的患者面临着独特的挑战。然而，很少有研究描述在患有NCCD的患者中，同时存在的MDD和GAD的负担与仅患有MDD或仅患有GAD的负担有何不同。
在本研究中，我们使用了2010 - 2017年医疗支出面板调查数据，以了解在患有NCCD的患者中，同时存在的MDD和GAD的经济和人文负担与单独患有MDD或GAD的负担有何不同。我们使用广义线性模型来研究这种关系，并控制了患者的社会人口统计学和临床特征。
同时存在MDD和GAD与每位患者每年的住院就诊次数、门诊就诊次数、急诊就诊次数、年度药品费用和总医疗费用增加有关。在患有3种及以上NCCD的患者中，仅患有MDD或GAD与日常生活活动（ADL）受限（分别为0.532和0.508）、社交受限（0.503，0.526）和身体受限（0.613，0.613）的较低比值比（OR）相关，与同时存在MDD和GAD相比。与同时存在MDD和GAD的患者相比，仅患有MDD或仅患有GAD与1 - 2种NCCD患者和3种及以上NCCD患者（分别为0.511，0.416）认知受限的显著较低几率（分别为0.659和0.461）相关。
与单独患有MDD或GAD相比，共病的MDD和GAD与更高的经济负担、更低的生活质量和更大的日常生活限制相关。与健康相关的经济和人文负担随着NCCD的数量增加而增加。
