Prevalence of Depression/Anxiety Among Medicare Beneficiaries with Chronic Obstructive Pulmonary Diseases and Association with Acute Exacerbations

RUHRC Authors: Blanchette, C
Publication Date: 04/19/2016
Full Publication: Prevalence of Depression/Anxiety Among Medicare Beneficiaries with Chronic Obstructive Pulmonary Diseases and Association with Acute Exacerbations

Abstract

Objective: To assess the association of exacerbations with depression/anxiety among Medicare beneficiaries with chronic obstructive pulmonary disease.

Methods: A prevalent cohort of Medicare beneficiaries aged 65+ with COPD (chronic bronchitis, emphysema, bronchiectasis, chronic airway obstruction) was constructed from a 5% sample of Medicare beneficiaries. Existence of depression/anxiety was identified via healthcare services or prescription drug claims. Baseline characteristics were assessed (1/1/2006-6/31/2006) and patients followed from first depression/anxiety claim until 12/31/2007 for all-cause and respiratory-related healthcare cost and utilization. Prevalence estimates of co-occurring COPD and depression/ anxiety were approximated. The occurrence and frequency of moderate (outpatient encounter with an oral corticosteroid and/or an antibiotic claim, or COPD-related emergency department visit) or severe (COPD-related hospital admission) COPD exacerbation was compared between patients with and without comorbid depression/anxiety using binary logistic and negative binomial regression models, respectively.

Results: 137,275 subjects met inclusion criteria. Depression/ anxiety was present in 45% (61,900). After controlling for sex, age, region, race, Charlson comorbidity score, use of COPDrelated medications, and moderate and severe exacerbations in the baseline period, enrollees with depression/anxiety were 54% more likely to have a moderate COPD exacerbation (OR 1.54, 95% CI 1.42-1.67) and 82% more likely to have a severe COPD exacerbation (OR 1.82, 95% CI 1.54-2.16).

Conclusion: Over half of Medicare beneficiaries with COPD also have depression/anxiety. Depression/anxiety is associated with a greater likelihood of COPD exacerbations. More attention to the co-existence and management of depression/anxiety among COPD patients may help reduce the occurrence and frequency of COPD exacerbations. Future research should explore the impact of managing depression/anxiety on reducing COPD exacerbations.

Suggested Citation

Blanchette CM, Roberts M, Petersen H, Fuhlbrigge A. Prevalence of Depression/Anxiety Among Medicare Beneficiaries with Chronic Obstructive Pulmonary Diseases and Association with Acute Exacerbations. Int J Respir Pulm Med. 2016;3:044.