TY - JOUR
T1 - Younger Adults Initiating Hemodialysis
T2 - Antidepressant Use for Depression Associated With Higher Health Care Utilization
AU - Vork, Diana L.
AU - Schneekloth, Terry D.
AU - Bartley, Adam C.
AU - Vaughan, Lisa E.
AU - Lapid, Maria I.
AU - Jowsey-Gregoire, Sheila G.
AU - El-Zoghby, Ziad M.
AU - Herrmann, Sandra M.
AU - Tran, Cheryl L.
AU - Albright, Robert C.
AU - Hickson, La Tonya J.
N1 - Funding Information:
Grant Support: The work was supported by a Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery award; the Extramural Grant Program by Satellite Healthcare, a not-for-profit renal care provider; a Mayo Clinic Rochester-Mayo Clinic Health System Integration award; and grant K23 DK109134 from the National Institute of Diabetes and Digestive and Kidney Diseases in the National Institutes of Health (L.J.H.). The work was also supported by grant UL1 TR000135 from the National Center for Advancing Translational Sciences. The content of the study is the sole responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
Publisher Copyright:
© 2017 Mayo Foundation for Medical Education and Research
PY - 2018/3
Y1 - 2018/3
N2 - Objective: To examine associations between antidepressant use and health care utilization in young adults beginning maintenance hemodialysis (HD) therapy. Patients and Methods: Antidepressant use, hospitalizations, and emergency department (ED) visits were examined in young adults (N=130; age, 18-44 years) initiating HD (from January 1, 2001, through December 31, 2013) at a midwestern US institution. Primary outcomes included hospitalizations and ED visits during the first year. Results: Depression diagnosis was common (47; 36.2%) at HD initiation, yet only 28 patients (21.5%) in the cohort were receiving antidepressant therapy. The antidepressant use group was more likely to have diabetes mellitus (18 [64.3%] vs 33 [32.4%]), coronary artery disease (8 [28.6%] vs 12 [11.8%]), and heart failure (9 [32.1%] vs 15 [14.7%]) (P<.05 for all) than the untreated group. Overall, 68 (52.3%) had 1 or more hospitalizations and 33 (25.4%) had 1 or more ED visits in the first year. The risk of hospitalization during the first year was higher in the antidepressant use group (hazard ratio, 2.35; 95% CI, 1.39-3.96; P=.001), which persisted after adjustment for diabetes, coronary artery disease, and heart failure (hazard ratio, 1.94; 95% CI, 1.22-3.10; P=.006). Emergency department visit rates were similar between the groups. Conclusion: Depression and antidepressant use for mood indication are common in young adult incident patients initiating HD and and are associated with higher hospitalization rates during the first year. Further research should determine whether antidepressants are a marker for other comorbidities or whether treated depression affects the increased health care use in these individuals.
AB - Objective: To examine associations between antidepressant use and health care utilization in young adults beginning maintenance hemodialysis (HD) therapy. Patients and Methods: Antidepressant use, hospitalizations, and emergency department (ED) visits were examined in young adults (N=130; age, 18-44 years) initiating HD (from January 1, 2001, through December 31, 2013) at a midwestern US institution. Primary outcomes included hospitalizations and ED visits during the first year. Results: Depression diagnosis was common (47; 36.2%) at HD initiation, yet only 28 patients (21.5%) in the cohort were receiving antidepressant therapy. The antidepressant use group was more likely to have diabetes mellitus (18 [64.3%] vs 33 [32.4%]), coronary artery disease (8 [28.6%] vs 12 [11.8%]), and heart failure (9 [32.1%] vs 15 [14.7%]) (P<.05 for all) than the untreated group. Overall, 68 (52.3%) had 1 or more hospitalizations and 33 (25.4%) had 1 or more ED visits in the first year. The risk of hospitalization during the first year was higher in the antidepressant use group (hazard ratio, 2.35; 95% CI, 1.39-3.96; P=.001), which persisted after adjustment for diabetes, coronary artery disease, and heart failure (hazard ratio, 1.94; 95% CI, 1.22-3.10; P=.006). Emergency department visit rates were similar between the groups. Conclusion: Depression and antidepressant use for mood indication are common in young adult incident patients initiating HD and and are associated with higher hospitalization rates during the first year. Further research should determine whether antidepressants are a marker for other comorbidities or whether treated depression affects the increased health care use in these individuals.
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U2 - 10.1016/j.mayocp.2017.12.008
DO - 10.1016/j.mayocp.2017.12.008
M3 - Article
C2 - 29502562
AN - SCOPUS:85042273108
SN - 0025-6196
VL - 93
SP - 321
EP - 332
JO - Mayo Clinic Proceedings
JF - Mayo Clinic Proceedings
IS - 3
ER -