Inovalon, Data Solutions, Bowie, MD.
Otsuka Pharmaceutical, Inc., Global Value and Real World Evidence, Princeton, NJ.
J Manag Care Spec Pharm. 2024 Sep;30(9):978-990. doi: 10.18553/jmcp.2024.30.9.978.
The relationship of patient characteristics and social determinants of health (SDOH) with hospitalizations and costs in patients with major depressive disorder (MDD) has not been assessed using real-world data.
To identify factors associated with higher hospitalizations and costs in patients with MDD.
A retrospective observational study identified patients aged 18 years and older newly diagnosed with MDD between July 1, 2016, and December 31, 2018. SDOH were linked to patients at the "near-neighborhood" level. Multivariable models assessed association of patient characteristics with hospitalizations (incidence rate ratios [95% CI]) and costs (cost ratios [95% CI]).
Of 1,958,532 patients with MDD, 49.6% had Commercial and 50.4% Medicaid insurance; mean ages were similar (43.9; 43.4) with more female patients (67.6%; 70.5%). MDD patients with Commercial insurance had a mean household income of $75,044; 53.2% were married; 76.5% owned their home; 64.4% completed high school or less; and 2.8% had limited English-language proficiency (LEP). Patients covered by Medicaid had a household income of $46,708; 68.1% lived alone with 41.6% married; 54.6% owned their home; more than 4-in-5 patients (80.8%) completed high school or less, and 6.3% had LEP. Nearly one-third of Medicaid insured patients with MDD had at least 1 hospitalization (29.6%) with a mean length of stay 6.8 days; total health care costs were $21,467 annually. Commercially insured patients with MDD had 14.7% hospitalization rates with a length of stay of 5.9 days; total costs were $14,531. Multivariable models show female patients are less likely (Commercial 0.87; Medicaid 0.80; < 0.05), and patients with more comorbidities are more likely to be hospitalized (Commercial 1.33; Medicaid 1.27; < 0.05). All treatment classes relative to antidepressants only increased likelihood of hospitalizations-particularly antipsychotic+antianxiety use (Commercial 2.99; Medicaid 2.29)-and costs (Commercial 2.32; Medicaid 2.00) (all < 0.05). Household income was inversely associated with hospitalizations for both insured populations. LEP reduced the likelihood of hospitalizations by more than 70% among Medicaid patients (0.27, < 0.05) and was associated with higher costs for Commercial (2.01) but lower costs for Medicaid (0.37) ( < 0.05). Living in areas with no shortage of mental health practitioners was associated with higher hospitalizations and costs.
We identified patient characteristics associated with higher rates of hospitalizations and costs in patients with MDD in 2 insured populations. Female sex, higher comorbidities, and living in areas with no shortage of mental health practitioners were associated with higher hospitalizations and costs, whereas income was inversely associated with hospitalizations. The findings suggest disparities in access to care related to income, LEP, and availability of mental health practitioners that should be addressed to assure equitable care for patients with MDD.
使用真实世界数据评估了患者特征和社会决定因素（SDOH）与重度抑郁症（MDD）患者住院和费用之间的关系。
确定与 MDD 患者住院和费用较高相关的因素。
一项回顾性观察性研究确定了 2016 年 7 月 1 日至 2018 年 12 月 31 日期间新诊断为 MDD 的年龄在 18 岁及以上的患者。SDOH 与患者的“近邻”水平相关联。多变量模型评估了患者特征与住院（发病率比[95%CI]）和费用（成本比[95%CI]）的关系。
在 1958532 例 MDD 患者中，49.6%有商业保险，50.4%有医疗补助保险；平均年龄相似（43.9；43.4），女性患者较多（67.6%；70.5%）。商业保险的 MDD 患者的家庭平均收入为 75044 美元；53.2%已婚；76.5%拥有自己的住房；64.4%完成了高中或以下教育；2.8%英语水平有限（LEP）。医疗补助保险的患者家庭收入为 46708 美元；68.1%独居，41.6%已婚；54.6%拥有自己的住房；超过 4 分之 5 的患者（80.8%）完成了高中或以下教育，6.3%英语水平有限。近三分之一的有 MDD 的医疗补助保险患者至少有一次住院（29.6%），平均住院时间为 6.8 天；每年的总医疗费用为 21467 美元。有 MDD 的商业保险患者的住院率为 14.7%，住院时间为 5.9 天；总费用为 14531 美元。多变量模型显示，女性患者的住院可能性较小（商业保险 0.87；医疗补助保险 0.80；<0.05），合并症较多的患者住院的可能性较大（商业保险 1.33；医疗补助保险 1.27；<0.05）。与仅使用抗抑郁药相比，所有治疗类别都增加了住院的可能性——特别是使用抗精神病药+抗焦虑药（商业保险 2.99；医疗补助保险 2.29）——和费用（商业保险 2.32；医疗补助保险 2.00）（均<0.05）。家庭收入与两个保险人群的住院率呈负相关。英语水平有限使医疗补助保险患者的住院可能性降低了 70%以上（0.27；<0.05），并与商业保险（2.01）的费用增加有关，但与医疗补助（0.37）的费用降低有关（<0.05）。生活在精神卫生服务人员不短缺的地区与较高的住院率和费用有关。
我们在两个保险人群中确定了与 MDD 患者较高住院率和费用相关的患者特征。女性、合并症较多和生活在精神卫生服务人员不短缺的地区与较高的住院率和费用相关，而收入与住院率呈负相关。这些发现表明，与收入、英语水平有限和精神卫生服务提供者的可用性相关的获得护理的机会存在差异，应加以解决，以确保 MDD 患者得到公平的护理。
