The prevalence of depressive disorder and its effect on acute exacerbation and mortality in patients with chronic obstructive pulmonary disease (COPD)
Date Issued
2015
Date
2015
Author(s)
Fu, Pin-Kuei
Abstract
Backgroud: Chronic obstructive pulmonary disease (COPD) is a chronic and complicated disease, which has a longer course and ofen merges many comorbidities. Since 2011, an additional chaper of comorbidities has been included in the COPD treatment guidelines in order to emphasize its importance. However, the impact of depression for COPD acute exacerbations and survival is still insufficient in Taiwan. Purpose: The purpose of current study is to investigate the prevalence of depressive disorder and its influence on the acute exacerbation and survial in patients with COPD in Taiwan. Materials and Methods: From Taiwan’s National Health Insurance Research Database, the Longitudinal Health Insurance Database (LHID) 2005, we collected data from 4 925 patients, including 985 COPD patients with depressive disorder and 3 940 age- and gender- matched (1:4) control COPD subjects without depressive disorder. Patients newly diagnosed as COPD (with more than 2 times of ambulatory visits diagnosed as COPD【ICD-9-CM: 491, 492, 496 or A323】or 1 times hospitalization with major diagnosis of COPD in 2005-2007 were included in the study. COPD patients aged younger than 40 years old or elder than 120 years old and those who have diagnosed as asthma at the same time were excluded. The comorbidity of depressive disorder included major【ICD-9-CM: 296.2,296.3】and minor depression【ICD-9-CM: 300.4, 309.0, 309.1, 311】were identified during the period of 1 Jan to 31 Dec in 2007. The severity of COPD was adjusted by the different formula of prescriptions. Cox proportional hazards model was performed to evaluate whether depressive disorder was the independent risk factors for acute exacerbation (in 2008) and survival (during 2008-2011) in patients with COPD. Results: The prevalence of depression comorbidity in patients with COPD is about 4.1%, which is far below most of the previous study reported in 20-25%. Meanwhile, the prevalence of depression was not in propotional to the severity of COPD. The findings of our study showed that the risk of acute exacerbation in COPD did not reach significant difference between depression and non-depression group (adjusted HR=1.02, 95% CI, 0.77-1.35, p=0.909). In addition, the results alos showed no significant difference in survival in COPD between depression and non-depression group (adjusted HR=1.07, 95% CI, 0.92-1.23, p=0.386). After adjusting the confounding factor of COPD severity, the influence of depressive disorder on the acute exacerbation and survial in COPD still not reached statistical significance. Conclusion: In comparision to the other common comorbidites in COPD, the prevalence of depressive comorbidity in Taiwan is far lower than other countries. COPD with depressive comorbidity did not increase the risk of acute exacerbation and death even adusting the severity of COPD. Whether this result is contributed to be underestimated of depressive comorbidity in COPD in Taiwan remans uncertain. Further investigation may be needed to corroborate the true prevalence of depressive comorbidity and its influence on COPD through intergrated COPD care process.
Subjects
COPD
Comorbidity
Depressive disorder
Acute exacerbation
Mortality
Type
thesis
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