New episodes of depression among Medicare beneficiaries with chronic obstructive pulmonary disease

Abstract

Objectives Depression is a common comorbidity of Chronic Obstructive Pulmonary Disease (COPD) and is associated with increased exacerbations, healthcare utilization, and mortality. Among Medicare beneficiaries newly diagnosed with COPD, the objectives of this study were to: 1) Estimate the rate of new episodes of depression; and 2) Identify factors associated with depression. Methods We identified beneficiaries with a first diagnosis of COPD during 2006-2012 using a 5% random sample of Medicare administrative claims data by searching for ICD-9-CM codes 490, 491.x, 492.x, 494.x, or 496. We identified episodes of depression using ICD-9-CM codes 296.2x, 296.3x, and 311.xx. We calculated incidence rates and their 95% confidence intervals (95% CI) and used a discrete time analysis to identify factors associated with development of depression. Results Between 2006-2012, 125,348 beneficiaries meeting inclusion criteria were newly diagnosed with COPD. Twenty-three percent developed depression following COPD diagnosis. The annualized incidence rate of depression per 100 beneficiaries following COPD diagnosis was 9.4 (95% CI 9.3, 9.5). Rates were highest in the first two months following COPD diagnosis. COPD diagnosis was associated with increased risk of depression (risk ratio (RR) 1.76; 95% CI 1.73, 1.79) as were COPD-related hospitalizations (RR 4.59; 95% CI 4.09, 5.15), a measure of COPD severity. Conclusions Diagnosis of COPD increases the risk of depression. This study will aid in the allocation of resources to monitor and provide support for individuals with COPD at high risk of developing depression.

Adherence and healthcare utilization among older adults with COPD and depression

“…These ICD-9-CM codes are used by CMS to identify beneficiaries with COPD and related disorders and have been used in several published analyses of administrative claims data. 8,14,15,22,25 …”

“…These codes have been used previously and exclude bipolar disorder, schizoaffective disorder, and dysthymic disorder. 8,11,22,26–28 Presence of depression was defined as at least one diagnosis code on at least 1 inpatient claim or 2 outpatient claims during the study period. To be included in our study cohort, we required a diagnosis of depression at least once following initial COPD diagnosis.…”

Algorithms to identify COPD in health systems with and without access to ICD coding: a systematic review

“…Thus, both publications do not specify which algorithms were used for the identification of COPD patients from the datasets. Eight studies were excluded, because they used ICD codes only (Albrecht et al 2016 [14]; Fortin et al 2017 [15]; Schwarzkopf et al 2016 [16]), or because they only reported the study protocol (Josephs et al 2017 [17]), or because they did not differentiate between asthma and COPD (Marrie et al 2016 [18]; Oelsner et al 2016 [19]). One publication was excluded, because it duplicated another publication (Vozoris et al 2016 [20]), and one study was excluded, because it investigated a different disease (Pollmanns et al 2018 [21]).…”

Psychiatric and Medical Comorbidity in the Primary Care Geriatric Patient—An Update

“…Among Medicare beneficiaries, 23 % with an incident diagnosis of COPD were subsequently diagnosed with depression. The risk of depression was elevated fourfold among those with a COPD-related hospitalization [5]. COPD may also increase risk for dementia [6].…”