Sex, Depression, and Risk of Hospitalization and Mortality in Chronic Obstructive Pulmonary Disease

Fan, Vincent S.; Ramsey, Scott D.; Giardino, Nicholas D.; Make, Barry J.; Emery, Charles F.; Diaz, Phillip; Benditt, Joshua O.; Mosenifar, Zab; McKenna, Robert J.; Curtis, Jeffrey L.; Fishman, Alfred P.; Martínez, Fernando J.

doi:10.1001/archinte.167.21.2345

Cited by 165 publications

(172 citation statements)

References 56 publications

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“…20 Some studies have demonstrated only a weak association between psychological disturbance 22 or health-related quality of life 11 and mortality in COPD patients. Yet, depressive symptoms were found to be strong predictors for mortality (odds ratios ͓ORs͔, 1.9, 23 3.6, 24 and 2.7 25 ), independent of other disease severity and other risk factors, in COPD patients in three studies. It is noteworthy that two of the studies 23,24 focused on COPD patients who had been hospitalized for acute exacerbation.…”

Section: Original Researchmentioning

confidence: 90%

“…The assessment of the depression symptoms was conducted during or shortly after (within 2 to 4 weeks) hospitalization for an exacerbation, which may have been reflected in increased the levels of depressive symptomatology. Only one study 25 demonstrated that adjusted depressive symptoms were associated with 3-year mortality and not with 1-year mortality in stable COPD patients. In contrast, two other studies 26,27 did not find an association between mortality and depression after adjustment for disease severity.…”

Section: Original Researchmentioning

confidence: 99%

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Depressive Symptoms as Predictors of Mortality in Patients With COPD

Voogd

Wempe

Koëter

et al. 2009

Chest

162

103

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Section: Original Researchmentioning

confidence: 90%

Section: Original Researchmentioning

confidence: 99%

Depressive Symptoms as Predictors of Mortality in Patients With COPD

Voogd

Wempe

Koëter

et al. 2009

Chest

162

103

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“…Although many medical comorbidities play a role in respiratory decompensation and rehospitalization (22,23), the impact on readmissions of psychological comorbidities such as depression and anxiety, which are highly prevalent in patients with COPD and affect quality of life, remains largely unexplored (24,25). In small cohorts, data showed that depressive symptoms in patients with COPD predicted exacerbation risk over 1 year (26,27).…”

mentioning

confidence: 99%

Depression Is Associated with Readmission for Acute Exacerbation of Chronic Obstructive Pulmonary Disease

et al. 2016

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Rationale: Hospitalization for acute exacerbation of chronic obstructive pulmonary disease (COPD) is associated with significant morbidity and health care costs, and hospitals in the United States are now penalized by the Centers for Medicare and Medicaid Services for excessive readmissions. Identifying patients at risk of readmission is important, but modifiable risk factors have not been clearly established, and the potential contributing role of psychological disease has not been examined adequately. We hypothesized that depression and anxiety would increase the risk of both short-and long-term readmissions for acute exacerbation of COPD.Objectives: To characterize the associations between depression and anxiety and COPD readmission risk. Methods:We examined the medical records for all patients with a primary diagnosis of acute exacerbation of COPD by International Classification of Diseases, Ninth Revision codes admitted to the University of Alabama at Birmingham Hospital between November 2010 and October 2012. Those who did not meet the standardized study criteria for acute exacerbation of COPD and those with other respiratory illnesses as the primary diagnosis were excluded. Comorbidities were recorded on the basis of physician documentation of the diagnosis and/or the use of medications in the electronic medical record. Multivariable regression analyses identified factors associated with readmission for acute exacerbation of COPD at 1 year and within 30 and 90 days.Measurements and Main Results: Four hundred twenty-two patients were included, with 132 readmitted in 1 year. Mean age was 64.8 6 11.7 years, and mean percent predicted FEV 1 was 48.1 6 18.7%. On univariate analysis, readmitted patients had lower percent predicted FEV 1 (44.9 6 17.3% vs. 50.2 6 19.4%; P = 0.05) and a higher frequency of depression (47.7% vs. 23.4%; P , 0.001). On multivariable analysis, 1-year readmission was independently associated with depression (adjusted odds ratio [OR], 2.67; 95% confidence interval [CI], 1.59-4.47) and in-hospital tobacco cessation counseling (adjusted OR, 0.34; 95% CI, 0.18-0.66). Depression also predicted readmission at 30 days (adjusted OR, 3.83; 95% CI, 1.84-7.96) and 90 days (adjusted OR, 2.47; 95% CI, 1.34-4.55).Conclusions: Depression is an independent risk factor for both short-and long-term readmissions for acute exacerbation of COPD and may represent a modifiable risk factor. In-hospital tobacco cessation counseling was also associated with reduced 1-year readmission.

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“…Among patients with COPD, depression remains one of the most common, yet least recognized and undertreated, comorbidities, with a prevalence of 17-44% (21)(22)(23)(24)(25)(26)(27). Depression has been associated with decreased adherence to maintenance medications used in chronic conditions such as diabetes (28,29).…”

mentioning

confidence: 99%

Adherence to Maintenance Medications among Older Adults with Chronic Obstructive Pulmonary Disease. The Role of Depression

et al. 2016

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Rationale: Among individuals with chronic obstructive pulmonary disease (COPD), depression is one of the most common yet underrecognized and undertreated comorbidities. Although depression has been associated with reduced adherence to maintenance medications used in other conditions, such as diabetes, little research has assessed the role of depression in COPD medication use and adherence.Objectives: The objective of this study was to assess the impact of depression on COPD maintenance medication adherence among a nationally representative sample of Medicare beneficiaries newly diagnosed with COPD. Methods:We used a 5% random sample of Medicare administrative claims data to identify beneficiaries diagnosed with COPD between 2006 and 2010. We included beneficiaries with 2 years of continuous Medicare Parts A, B, and D coverage and at least two prescription fills for COPD maintenance medications after COPD diagnosis. We searched for prescription fills for inhaled corticosteroids, long-acting b-agonists, and long-acting anticholinergics and calculated adherence starting at the first fill. We modeled adherence to COPD maintenance medications as a function of new episodes of depression, using generalized estimated equations.Measurements and Main Results: Our primary outcome was adherence to COPD maintenance medications, measured as proportion of days covered. The exposure measure was depression. Both COPD and depression were assessed using diagnostic codes in Part A and B data. Covariates included sociodemographics, as well as clinical markers, including comorbidities, COPD severity, and depression severity. Of 31,033 beneficiaries meeting inclusion criteria, 6,227 (20%) were diagnosed with depression after COPD diagnosis. Average monthly adherence to COPD maintenance medications was low, peaking at 57% in the month after first fill and decreasing to 35% within 6 months. In our adjusted regression model, depression was associated with decreased adherence to COPD maintenance medications (odds ratio, 0.93; 95% confidence interval, 0.89-0.98).Conclusions: New episodes of depression decreased adherence to maintenance medications used to manage COPD among older adults. Clinicians who treat older adults with COPD should be aware of the development of depression, especially during the first 6 months after COPD diagnosis, and monitor patients' adherence to prescribed COPD medications to ensure best clinical outcomes.

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Sex, Depression, and Risk of Hospitalization and Mortality in Chronic Obstructive Pulmonary Disease

Cited by 165 publications

References 56 publications

Depressive Symptoms as Predictors of Mortality in Patients With COPD

Depressive Symptoms as Predictors of Mortality in Patients With COPD

Depression Is Associated with Readmission for Acute Exacerbation of Chronic Obstructive Pulmonary Disease

Adherence to Maintenance Medications among Older Adults with Chronic Obstructive Pulmonary Disease. The Role of Depression

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