Psychiatric Comorbidities and Mortality among Hospitalized Parkinson Disease Patients (P06.068)

Abstract

Objective: We hypothesized that Parkinson disease (PD) patients diagnosed with depression or anxiety would have higher in-hospital mortality compared to PD patients with no psychiatric comorbidities. Alcohol or drug use would further increase mortality. Background Community-based and clinical studies estimate 20-40% PD patients suffer from anxiety, 25-95% have depressive symptoms, and at least 8% meet major depression criteria. About 75% of PD patients develop depression within 10 years of PD onset, with almost a two-fold risk of depression than others. Psychiatric comorbidities seem to negatively affect PD patients9 quality of life and survival. Design/Methods: We used 1998-2009 Healthcare Cost and Utilization Project Nationwide Inpatient Sample (HCUP-NIS) to test our hypotheses. We identified PD, depression, anxiety, alcohol and drug use through International Classification of Diseases, 9th Revision (ICD-9) codes. Descriptive statistics summarized patient differences before data analyses. Logistic regressions used SAS survey procedures and HCUP-NIS sampling weights to account for complex survey design. All models considered patients9 age, gender, race/ethnicity, and insurance type. Results: 3,599,901 discharges met inclusion criteria, with age 77.8 (SD 9.2), 52.9% male; 65.1% White; 8.1% private/HMO insurance. Depression was identified in 11.2%, anxiety in 5.3%, underestimates to population predicted prevalence of those disorders in same settings. Statistically lower mortality was found for PD patients with known depression (OR=0.65; p Conclusions: We postulate that depression and anxiety are under diagnosed in hospitalized PD patients but associated with lower in-hospital PD mortality when recognized. Alcohol and illicit substance use did not impact outcome for PD patients with psychiatric co-morbidities, but these seemed to be under recognized. Asian race as well as Medicaid and uninsurance were associated with higher odds of inpatient death. Supported by: Dr. Mejia is a 2010-2012 AAN Foundation Clinical Research Training Fellowship recipient and a 2011 Rappaport Foundation Research Scholar in Neuroscience. Disclosure: Dr. Mejia has nothing to disclose. Dr. El-Chemali has nothing to disclose.