Association of Depression Risk with Patient Experience, Healthcare Expenditure, and Health Resource Utilization Among Adults with Atherosclerotic Cardiovascular Disease

Victor Okunrintemi, Javier Valero-Elizondo, Erin D. Michos, Joseph A. Salami, Oluseye Ogunmoroti, Chukwuemeka Osondu, Martin Tibuakuu, Eve Marie Benson, Timothy M. Pawlik, Michael J. Blaha, Khurram Nasir

Research output: Contribution to journalArticle

Abstract

Background: Approximately 20% of patients with atherosclerotic cardiovascular disease (ASCVD) suffer from depression. Objective: To compare healthcare expenditures and utilization, healthcare-related quality of life, and patient-centered outcomes among ASCVD patients, based on their risk for depression (among those without depression), and those with depression (vs. risk-stratified non-depressed). Design and Setting: The 2004–2015 Medical Expenditure Panel Survey (MEPS) was used for this study. Participants: Adults ≥ 18 years with a diagnosis of ASCVD, ascertained by ICD-9 codes and/or self-reported data. Individuals with a diagnosis of depression were identified by ICD-9 code 311. Participants were stratified by depression risk, based on the Patient Health Questionnaire-2. Results: A total of 19,840 participants were included, translating into 18.3 million US adults, of which 8.6% (≈ 1.3 million US adults) had a high risk for depression and 18% had a clinical diagnosis of depression. Among ASCVD patients without depression, those with a high risk (compared with low risk) had increased overall and out-of-pocket expenditures (marginal differences of $2880 and $287, respectively, both p < 0.001), higher odds for resource utilization, and worse patient experience and healthcare quality of life (HQoL). Furthermore, compared with individuals who had depression, participants at high risk also reported worse HQoL and had higher odds of poor perception of their health status (OR 1.83, 95% CI [1.50, 2.23]) and poor patient-provider communication (OR 1.29 [1.18, 1.42]). Limitation: The sample population includes self-reported diagnosis of ASCVD; therefore, the risk of underestimation of the cohort size cannot be ruled out. Conclusion: Almost 1 in 10 individuals with ASCVD without diagnosis of depression is at high risk for it and has worse health outcomes compared with those who already have a diagnosis of depression. Early recognition and treatment of depression may increase healthcare efficiency, positive patient experience, and HQoL among this vulnerable population.

Original languageEnglish (US)
JournalJournal of general internal medicine
DOIs
StateAccepted/In press - Jan 1 2019

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Health Resources
Health Expenditures
Cardiovascular Diseases
Depression
Delivery of Health Care
International Classification of Diseases
Quality of Life
Health
Vulnerable Populations
Health Status

Keywords

  • atherosclerotic cardiovascular disease
  • depression
  • healthcare economics
  • healthcare-related quality of life
  • patient experience

ASJC Scopus subject areas

  • Internal Medicine

Cite this

Association of Depression Risk with Patient Experience, Healthcare Expenditure, and Health Resource Utilization Among Adults with Atherosclerotic Cardiovascular Disease. / Okunrintemi, Victor; Valero-Elizondo, Javier; Michos, Erin D.; Salami, Joseph A.; Ogunmoroti, Oluseye; Osondu, Chukwuemeka; Tibuakuu, Martin; Benson, Eve Marie; Pawlik, Timothy M.; Blaha, Michael J.; Nasir, Khurram.

In: Journal of general internal medicine, 01.01.2019.

Research output: Contribution to journalArticle

Okunrintemi, Victor ; Valero-Elizondo, Javier ; Michos, Erin D. ; Salami, Joseph A. ; Ogunmoroti, Oluseye ; Osondu, Chukwuemeka ; Tibuakuu, Martin ; Benson, Eve Marie ; Pawlik, Timothy M. ; Blaha, Michael J. ; Nasir, Khurram. / Association of Depression Risk with Patient Experience, Healthcare Expenditure, and Health Resource Utilization Among Adults with Atherosclerotic Cardiovascular Disease. In: Journal of general internal medicine. 2019.
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abstract = "Background: Approximately 20{\%} of patients with atherosclerotic cardiovascular disease (ASCVD) suffer from depression. Objective: To compare healthcare expenditures and utilization, healthcare-related quality of life, and patient-centered outcomes among ASCVD patients, based on their risk for depression (among those without depression), and those with depression (vs. risk-stratified non-depressed). Design and Setting: The 2004–2015 Medical Expenditure Panel Survey (MEPS) was used for this study. Participants: Adults ≥ 18 years with a diagnosis of ASCVD, ascertained by ICD-9 codes and/or self-reported data. Individuals with a diagnosis of depression were identified by ICD-9 code 311. Participants were stratified by depression risk, based on the Patient Health Questionnaire-2. Results: A total of 19,840 participants were included, translating into 18.3 million US adults, of which 8.6{\%} (≈ 1.3 million US adults) had a high risk for depression and 18{\%} had a clinical diagnosis of depression. Among ASCVD patients without depression, those with a high risk (compared with low risk) had increased overall and out-of-pocket expenditures (marginal differences of $2880 and $287, respectively, both p < 0.001), higher odds for resource utilization, and worse patient experience and healthcare quality of life (HQoL). Furthermore, compared with individuals who had depression, participants at high risk also reported worse HQoL and had higher odds of poor perception of their health status (OR 1.83, 95{\%} CI [1.50, 2.23]) and poor patient-provider communication (OR 1.29 [1.18, 1.42]). Limitation: The sample population includes self-reported diagnosis of ASCVD; therefore, the risk of underestimation of the cohort size cannot be ruled out. Conclusion: Almost 1 in 10 individuals with ASCVD without diagnosis of depression is at high risk for it and has worse health outcomes compared with those who already have a diagnosis of depression. Early recognition and treatment of depression may increase healthcare efficiency, positive patient experience, and HQoL among this vulnerable population.",
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AU - Okunrintemi, Victor

AU - Valero-Elizondo, Javier

AU - Michos, Erin D.

AU - Salami, Joseph A.

AU - Ogunmoroti, Oluseye

AU - Osondu, Chukwuemeka

AU - Tibuakuu, Martin

AU - Benson, Eve Marie

AU - Pawlik, Timothy M.

AU - Blaha, Michael J.

AU - Nasir, Khurram

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N2 - Background: Approximately 20% of patients with atherosclerotic cardiovascular disease (ASCVD) suffer from depression. Objective: To compare healthcare expenditures and utilization, healthcare-related quality of life, and patient-centered outcomes among ASCVD patients, based on their risk for depression (among those without depression), and those with depression (vs. risk-stratified non-depressed). Design and Setting: The 2004–2015 Medical Expenditure Panel Survey (MEPS) was used for this study. Participants: Adults ≥ 18 years with a diagnosis of ASCVD, ascertained by ICD-9 codes and/or self-reported data. Individuals with a diagnosis of depression were identified by ICD-9 code 311. Participants were stratified by depression risk, based on the Patient Health Questionnaire-2. Results: A total of 19,840 participants were included, translating into 18.3 million US adults, of which 8.6% (≈ 1.3 million US adults) had a high risk for depression and 18% had a clinical diagnosis of depression. Among ASCVD patients without depression, those with a high risk (compared with low risk) had increased overall and out-of-pocket expenditures (marginal differences of $2880 and $287, respectively, both p < 0.001), higher odds for resource utilization, and worse patient experience and healthcare quality of life (HQoL). Furthermore, compared with individuals who had depression, participants at high risk also reported worse HQoL and had higher odds of poor perception of their health status (OR 1.83, 95% CI [1.50, 2.23]) and poor patient-provider communication (OR 1.29 [1.18, 1.42]). Limitation: The sample population includes self-reported diagnosis of ASCVD; therefore, the risk of underestimation of the cohort size cannot be ruled out. Conclusion: Almost 1 in 10 individuals with ASCVD without diagnosis of depression is at high risk for it and has worse health outcomes compared with those who already have a diagnosis of depression. Early recognition and treatment of depression may increase healthcare efficiency, positive patient experience, and HQoL among this vulnerable population.

AB - Background: Approximately 20% of patients with atherosclerotic cardiovascular disease (ASCVD) suffer from depression. Objective: To compare healthcare expenditures and utilization, healthcare-related quality of life, and patient-centered outcomes among ASCVD patients, based on their risk for depression (among those without depression), and those with depression (vs. risk-stratified non-depressed). Design and Setting: The 2004–2015 Medical Expenditure Panel Survey (MEPS) was used for this study. Participants: Adults ≥ 18 years with a diagnosis of ASCVD, ascertained by ICD-9 codes and/or self-reported data. Individuals with a diagnosis of depression were identified by ICD-9 code 311. Participants were stratified by depression risk, based on the Patient Health Questionnaire-2. Results: A total of 19,840 participants were included, translating into 18.3 million US adults, of which 8.6% (≈ 1.3 million US adults) had a high risk for depression and 18% had a clinical diagnosis of depression. Among ASCVD patients without depression, those with a high risk (compared with low risk) had increased overall and out-of-pocket expenditures (marginal differences of $2880 and $287, respectively, both p < 0.001), higher odds for resource utilization, and worse patient experience and healthcare quality of life (HQoL). Furthermore, compared with individuals who had depression, participants at high risk also reported worse HQoL and had higher odds of poor perception of their health status (OR 1.83, 95% CI [1.50, 2.23]) and poor patient-provider communication (OR 1.29 [1.18, 1.42]). Limitation: The sample population includes self-reported diagnosis of ASCVD; therefore, the risk of underestimation of the cohort size cannot be ruled out. Conclusion: Almost 1 in 10 individuals with ASCVD without diagnosis of depression is at high risk for it and has worse health outcomes compared with those who already have a diagnosis of depression. Early recognition and treatment of depression may increase healthcare efficiency, positive patient experience, and HQoL among this vulnerable population.

KW - atherosclerotic cardiovascular disease

KW - depression

KW - healthcare economics

KW - healthcare-related quality of life

KW - patient experience

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