Abstract
Objective. This analysis focuses on the effect of depression on the cost of hospitalization of stroke patients. Methods. Data on 17,010 stroke patients (primary diagnosis) were extracted from 2008 Tennessee Hospital Discharge Data System. Three groups of patients were compared: (1) stroke only (SO, n = 7,850), (2) stroke + depression (S+D, n = 3,965), and (3) stroke + other mental health diagnoses (S+M, n = 5,195). Results. Of all adult patients, 4.3% were diagnosed with stroke. Stroke was more prevalent among blacks than whites (4.5% versus 4.2%, P < 0.001) and among males than females (5.1% versus 3.7%, P < 0.001). Nearly one-quarter of stroke patients (23.3%) were diagnosed with depression/anxiety. Hospital stroke cost was higher among depressed stroke patients (S+D) compared to stroke only (SO) patients ($77,864 versus $47,790, P < 0.001), and among S+D, cost was higher for black males compared to white depressed males ($97,196 versus $88,115, P < 0.001). Similar racial trends in cost emerged among S+D females. Conclusion. Depression in stroke patients is associated with increased hospitalization costs. Higher stroke cost among blacks may reflect the impact of comorbidities and the delay in care of serious health conditions. Attention to early detection of depression in stroke patients might reduce inpatient healthcare costs.
Highlights
Stroke was higher among blacks compared to whites (4.5% versus 4.2%, resp., P < 0.0001; prevalence rates of 517.1 versus 322.0, resp.; odd ratios (ORs) = 1.31, 95% CI = 1.26–1.36 after controlling for risk factors, Table 1)
Stroke was more prevalent among males than females (5.1% versus 3.7%, P < 0.0001; rates of 374.1 versus 369.2 per 100 K; OR = 1.22, 95% CI = 1.18– 1.25)
Stroke was more common among black males compared to white males (5.8% versus 5.0%, P < 0.001; prevalence rates of 532.3 versus 351.0 per 100 K; OR = 1.31, 95% CI = 1.23–1.39) and among black females compared to white females (3.9% versus 3.7%, P < 0.02; prevalence rates of 505.7 versus 298.9 per 100 K; OR = 1.29, 95% CI = 1.22–1.37)
Summary
Between 20% and 60% of stroke patients are diagnosed with depression/anxiety [1], and these are often newly diagnosed in stroke patients both during hospitalization and up to 3 years after discharge [1,2,3,4,5,6,7,8,9,10,11,12,13,14,15,16,17,18,19,20]. Depression is associated with longer institutionalization and poorer rehabilitation outcomes [21, 22]. Depression increases the risk of stroke [28] as well as increased healthcare costs [29,30,31,32,33,34]. As these and other stroke related factors are evaluated, understanding their impact on healthcare cost is necessary for better management, improved therapeutic outcomes, and reduced healthcare cost.
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