Impact of Depression on Chronic Obstructive Pulmonary Disease Hospitalization Outcomes: Findings from a Portuguese Nationwide Study

• Main Author: Pedro Nuno Lobo Seabra de Farrajota Sebastião
• Publication Date: 2022
• Format: Master thesis
• Language: eng
• Source: Repositórios Científicos de Acesso Aberto de Portugal (RCAAP)
• Download full: https://hdl.handle.net/10216/142035
• topic: Medicina clínica; Clinical medicine

Abstract Objective: Depression is a frequent comorbidity of chronic obstructive pulmonary disease (COPD). This study aims to assess the impact of comorbid depression on COPD-related hospitalization outcomes in the context of the Portuguese National Health Service (NHS), and to explore their regional distribution. Methods: An observational retrospective study was conducted using administrative data regarding all hospitalizations with a primary diagnosis of COPD held in mainland Portuguese public hospitals (2000-2015). To select patients with a secondary diagnosis of depression, a dichotomous variable was created grouping ICD-9-CMcodes related to depressive disorders (296.2x, 296.3x, 300.4, and 311). To avoid potential bias, propensity score matching was used to select a comparable sample without depression. In-hospital mortality, length of stay (LoS), and estimated hospital charges were treated as outcomes. Univariate and multivariate analysis were performed and adjusted odds ratios (aOR) were calculated between patients' variables and chosen outcomes. Results: Of a total of 135378 hospitalizations with a primary diagnosis of COPD, 4389 cases had a concurrent depression code. According to 1:1 proportion for propensity score matching, 4245 patients without depression were selected. Comorbid depression increased LoS (aOR = 1.11; CI 95% = 1.07-1.15) and estimated hospital charges (aOR = 9.86; CI 95% = 8.48-11.46). While multivariate analysis showed no significant association of depression with mortality (aOR = 1.21; CI 95% = 0.88-1.37), univariate analysis revealed greater mortality in male patients (6.2% vs 4.5%; p=0.032). Conclusion: These results describe the impact depressive disorders have on COPD hospitalizations. Greater efforts should be made to diagnose and address these conditions to provide the best care and prevent patients' negative health outcomes.