Costs associated with depression and obesity among cardiovascular patients: medical expenditure panel survey analysis.

Publisher: BioMed Central Country of Publication: England NLM ID: 101088677 Publication Model: Electronic Cited Medium: Internet ISSN: 1472-6963 (Electronic) Linking ISSN: 14726963 NLM ISO Abbreviation: BMC Health Serv Res Subsets: MEDLINE

Original Publication: London : BioMed Central, [2001-

Depression*/epidemiology ; Health Expenditures*; Adolescent ; Adult ; Body Mass Index ; Delivery of Health Care ; Humans ; Obesity/complications ; Obesity/epidemiology ; United States/epidemiology

Background: There is a lack of information on the cost of depression associated with metabolic syndrome and cardiovascular diseases in the literature.
Methods: We evaluated the synergistic effects of depression and obesity on total expenditures for cardiovascular conditions using data from the Medical Expenditure Panel Survey (MEPS) database. We analyzed MEPS data from 1996 to 2017 comprising adult cardiovascular subjects. We categorized individuals following a combination of International Classification of Diseases ICD-9-CM and ICD-10 codes, and depression symptoms as evaluated using the Patient Health Questionnaire-2 (PHQ-2) depression screening tool. Our sample comprised cardiovascular patients aged 18 years and older, with a body mass index (BMI) between 18.5 and 60. Our study comprised unweighted sample of 96,697 (weighted sample of 938,835,031) adults, a US-nationwide representative sample of cardiovascular disease patients. The four response categories were: no depression; unrecognized depression; asymptomatic depression; and symptomatic depression. Our evaluated outcomes were total annual healthcare expenditures, including dental, emergency room, hospital outpatient, hospital inpatient, office-based, prescription, and home health care expenses.
Results: Asymptomatic and symptomatic depression was more frequent among obese individuals than in individuals with a normal BMI (p <  0.001). Total expenditure was highest among symptomatic depression individuals (17,536) and obese (9871) with cardiovascular disease. All the expenditure outcomes were significantly higher among symptomatic depression individuals than those without depression (p <  0.001), except for dental costs. All healthcare expenditures associated with obesity were higher compared to individuals with normal BMI with p <  0.001, except for emergency and home healthcare costs. Most importantly, among obese individuals, all healthcare expenditures were significantly higher (p <  0.001) in those with symptomatic depression than those without depression, except for dental costs, where the difference was not significant (0.899). Therefore, obesity and depression entail increased expenses in patients with cardiovascular disease.
Conclusions: We found incremental expenditures among unrecognized, asymptomatic, and symptomatic depressed individuals with obesity compared to non-depressed, non-obese subjects. However, these are preliminary results that should be further validated using different methodologies.

Cost Eff Resour Alloc. 2013 Feb 08;11(1):3. (PMID: 23394349)
J Am Coll Nutr. 2017 Mar-Apr;36(3):223-233. (PMID: 28394727)
Diabetes Care. 2021 Feb;44(2):407-415. (PMID: 33318124)
Eur Heart J. 2006 Jul;27(13):1610-9. (PMID: 16495286)
Crit Care. 2020 Aug 5;24(1):485. (PMID: 32758295)
Am J Prev Med. 2013 May;44(5):453-8. (PMID: 23597807)
Res Social Adm Pharm. 2008 Sep;4(3):244-57. (PMID: 18794035)
J Health Psychol. 2008 Nov;13(8):1190-7. (PMID: 18987092)
Arch Gen Psychiatry. 2010 Mar;67(3):220-9. (PMID: 20194822)
J Cardiopulm Rehabil Prev. 2009 Nov-Dec;29(6):358-64. (PMID: 19940639)
J Obes. 2016;2016:9040248. (PMID: 26904277)
Public Health Rep. 2010 Jul-Aug;125(4):596-604. (PMID: 20597460)
World Psychiatry. 2017 Jun;16(2):163-180. (PMID: 28498599)
J Clin Endocrinol Metab. 2017 Jun 1;102(6):1934-1942. (PMID: 28323999)
Nat Rev Endocrinol. 2015 Jan;11(1):55-62. (PMID: 25265977)
Epidemiol Psychiatr Sci. 2019 Apr 05;29:e30. (PMID: 30947759)
Health Econ. 1994 Sep-Oct;3(5):333-45. (PMID: 7827649)
Can J Psychiatry. 2015 Jan;60(1):31-4. (PMID: 25886547)
Br J Psychiatry. 2015 Apr;206(4):332-8. (PMID: 24925985)
Nat Rev Dis Primers. 2020 Aug 20;6(1):69. (PMID: 32820163)
J Obes. 2015;2015:298698. (PMID: 25741444)
Arch Intern Med. 2002 Sep 9;162(16):1860-6. (PMID: 12196084)
J Am Coll Cardiol. 2019 Apr 16;73(14):1827-1845. (PMID: 30975301)
Diabetes Metab Syndr Obes. 2016 Feb 26;9:37-46. (PMID: 27013897)
Circ Res. 2020 May 22;126(11):1477-1500. (PMID: 32437302)
Lancet. 2018 Nov 10;392(10159):1789-1858. (PMID: 30496104)
Health Psychol. 2010 May;29(3):293-8. (PMID: 20496983)
Obes Rev. 2011 Jan;12(1):50-61. (PMID: 20059703)
Epidemiology. 2014 May;25(3):454-61. (PMID: 24608666)
Gerontol Geriatr Med. 2016 Jan 19;2:2333721415622004. (PMID: 28138482)
Value Health. 2011 Jun;14(4):492-8. (PMID: 21669374)
Can J Psychiatry. 2020 May;65(5):338-346. (PMID: 31835904)
J Clin Psychiatry. 2015 Feb;76(2):155-62. (PMID: 25742202)
Prev Med. 2007 Oct;45(4):247-51. (PMID: 17950122)
Clin Obes. 2016 Jun;6(3):225-31. (PMID: 27097821)
Sci Rep. 2014 Aug 15;4:6085. (PMID: 25124526)
Am J Psychiatry. 2006 Dec;163(12):2141-7. (PMID: 17151166)
J Manag Care Spec Pharm. 2020 Aug;26(8):996-1007. (PMID: 32552362)
Am Heart J. 2006 Jul;152(1):140-8. (PMID: 16824844)
J Affect Disord. 2018 Aug 1;235:399-406. (PMID: 29677604)
Prog Cardiovasc Dis. 2013 May-Jun;55(6):511-23. (PMID: 23621961)
J Stroke. 2017 May;19(2):213-221. (PMID: 28592783)
Aust N Z J Psychiatry. 2014 Aug;48(8):735-42. (PMID: 24589979)
J Am Coll Cardiol. 2009 Jan 13;53(2):176-83. (PMID: 19130986)
Depress Anxiety. 2014 Jun;31(6):459-71. (PMID: 24272961)
Psychiatriki. 2019 Oct-Dec;30(4):281-290. (PMID: 32283531)
J Gen Intern Med. 2011 Nov;26(11):1284-90. (PMID: 21710312)
Depress Anxiety. 2020 Nov;37(11):1146-1159. (PMID: 32579794)
J Gen Intern Med. 2016 Jun;31(6):615-22. (PMID: 26969312)
Am J Hypertens. 2012 Apr;25(4):505-11. (PMID: 22258334)
Med Care. 2003 Nov;41(11):1284-92. (PMID: 14583691)
Scand J Public Health. 2011 Dec;39(8):857-63. (PMID: 21965477)
Health Promot Perspect. 2013 Jun 30;3(1):11-22. (PMID: 24688948)
Inform Prim Care. 2012;20(4):221-4. (PMID: 23890332)
JAMA. 1997 May 28;277(20):1618-23. (PMID: 9168292)

Keywords: Cardiovascular conditions; Cost; Depression; Obesity

Date Created: 20210507 Date Completed: 20210514 Latest Revision: 20210514

20221213

PMC8101168

10.1186/s12913-021-06428-x

33957919