Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
BMC Health Services Research
Published in: BMC Health Services Research 1/2021

Open Access 01-12-2021 | Obesity | Research article

Costs associated with depression and obesity among cardiovascular patients: medical expenditure panel survey analysis

Authors: Felipe Saia Tápias, Victor Henrique Oyamada Otani, Daniel Augusto Corrêa Vasques, Thais Zelia Santos Otani, Ricardo Riyoiti Uchida

Published in: BMC Health Services Research | Issue 1/2021

Login to get access

Abstract

Background

There is a lack of information on the cost of depression associated with metabolic syndrome and cardiovascular diseases in the literature.

Methods

We evaluated the synergistic effects of depression and obesity on total expenditures for cardiovascular conditions using data from the Medical Expenditure Panel Survey (MEPS) database. We analyzed MEPS data from 1996 to 2017 comprising adult cardiovascular subjects. We categorized individuals following a combination of International Classification of Diseases ICD-9-CM and ICD-10 codes, and depression symptoms as evaluated using the Patient Health Questionnaire-2 (PHQ-2) depression screening tool. Our sample comprised cardiovascular patients aged 18 years and older, with a body mass index (BMI) between 18.5 and 60. Our study comprised unweighted sample of 96,697 (weighted sample of 938,835,031) adults, a US-nationwide representative sample of cardiovascular disease patients. The four response categories were: no depression; unrecognized depression; asymptomatic depression; and symptomatic depression. Our evaluated outcomes were total annual healthcare expenditures, including dental, emergency room, hospital outpatient, hospital inpatient, office-based, prescription, and home health care expenses.

Results

Asymptomatic and symptomatic depression was more frequent among obese individuals than in individuals with a normal BMI (p <  0.001). Total expenditure was highest among symptomatic depression individuals (17,536) and obese (9871) with cardiovascular disease. All the expenditure outcomes were significantly higher among symptomatic depression individuals than those without depression (p <  0.001), except for dental costs. All healthcare expenditures associated with obesity were higher compared to individuals with normal BMI with p <  0.001, except for emergency and home healthcare costs. Most importantly, among obese individuals, all healthcare expenditures were significantly higher (p <  0.001) in those with symptomatic depression than those without depression, except for dental costs, where the difference was not significant (0.899). Therefore, obesity and depression entail increased expenses in patients with cardiovascular disease.

Conclusions

We found incremental expenditures among unrecognized, asymptomatic, and symptomatic depressed individuals with obesity compared to non-depressed, non-obese subjects. However, these are preliminary results that should be further validated using different methodologies.
Appendix
Available only for authorised users
Literature
1.
James SL, Abate D, Abate KH, et al. Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990–2017: a systematic analysis for the global burden of disease study 2017. Lancet. 2018;392(10159):1789–858.CrossRef
2.
3.
Elderon L, Whooley MA. Depression and cardiovascular disease. Prog Cardiovasc Dis. 2013;55(6):511–23.PubMedCrossRef
4.
Jha MK, Qamar A, Vaduganathan M, Charney DS, Murrough JW. Screening and management of depression in patients with cardiovascular disease: JACC state-of-the-art review. J Am Coll Cardiol. 2019;73(14):1827–45.PubMedPubMedCentralCrossRef
5.
Correll CU, Solmi M, Veronese N, et al. Prevalence, incidence and mortality from cardiovascular disease in patients with pooled and specific severe mental illness: a large-scale meta-analysis of 3,211,768 patients and 113,383,368 controls. World Psychiatry. 2017;16(2):163–80.PubMedPubMedCentralCrossRef
6.
Rutledge T, Vaccarino V, Johnson BD, et al. Depression and cardiovascular health care costs among women with suspected myocardial ischemia: prospective results from the WISE (Women’s ischemia syndrome evaluation) study. J Am Coll Cardiol. 2009;53(2):176–83.PubMedPubMedCentralCrossRef
7.
Pereira-Miranda E, Costa PR, Queiroz VA, Pereira-Santos M, Santana ML. Overweight and obesity associated with higher depression prevalence in adults: a systematic review and meta-analysis. J Am Coll Nutr. 2017;36(3):223–33.PubMedCrossRef
8.
Mahanta TG, Joshi R, Mahanta B, Gogoi P. Determinants of metabolic syndrome (MetS) amongst persons living in Dibrugarh District of Assam. Clin Epidemiology Glob Health. 2017;5(2):52–61.CrossRef
9.
Greenberg PE, Fournier A-A, Sisitsky T, Pike CT, Kessler RC. The economic burden of adults with major depressive disorder in the United States (2005 and 2010). J Clin Psychiatry. 2015 Feb;76(2):155–62.PubMedCrossRef
10.
11.
Tran BX, Nair AV, Kuhle S, Ohinmaa A, Veugelers PJ. Cost analyses of obesity in Canada: scope, quality, and implications. Cost Eff Resour Alloc. 2013;11(1):3.PubMedPubMedCentralCrossRef
12.
Leal J, Luengo-Fernández R, Gray A, Petersen S, Rayner M. Economic burden of cardiovascular diseases in the enlarged European Union. Eur Heart J. 2006;27(13):1610–9.PubMedCrossRef
13.
Rudisill C, Charlton J, Booth HP, Gulliford MC. Are healthcare costs from obesity associated with body mass index, comorbidity or depression? Cohort study using electronic health records. Clin Obes. 2016;6(3):225–31.PubMedPubMedCentralCrossRef
14.
Simon GE, Arterburn D, Rohde P, et al. Obesity, depression, and health services costs among middle-aged women. J Gen Intern Med. 2011;26(11):1284–90.PubMedPubMedCentralCrossRef
15.
Liyanage H, Liaw S-T, de Lusignan S. Reporting of studies conducted using observational routinely collected data (RECORD) statement: call for contributions from the clinical informatics community. Inform Prim Care. 2012;20(4):221–4.PubMed
16.
Von Elm E, Altman DG, Egger M, et al. The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. Prev Med. 2007;45(4):247–51.CrossRef
17.
18.
Egede LE, Walker RJ, Bishu K, Dismuke CE. Trends in costs of depression in adults with diabetes in the United States: medical expenditure panel survey, 2004-2011. J Gen Intern Med. 2016;31(6):615–22.PubMedPubMedCentralCrossRef
19.
Kroenke K, Spitzer RL, Williams JBW. The patient health questionnaire-2: validity of a two-item depression screener. Med Care. 2003;41(11):1284–92.PubMedCrossRef
20.
21.
Béland S-G, Tournier M. Galbaud du fort G, et al. economic impact of nonpersistence with antidepressant treatment in the adult population of Quebec: a comparative cost-effectiveness approach. Value Health. 2011;14(4):492–8.PubMedCrossRef
22.
23.
Kuhn M, Johnson K. Applied predictive modeling. New York: Springer-Verlag; 2013. p. 57–60.CrossRef
24.
Rutten-van Mölken MP, Van EK, van Vliet RC. Statistical analysis of cost outcomes in a randomized controlled clinical trial. Health Econom. 1994;3(5):333–45.CrossRef
25.
Benjamini Y, Hochberg Y. Controlling the false discovery rate: a practical and powerful approach to multiple testing. J R Stat Soc Series B (Methodological). 1995;57(1):289–300.
26.
Korn EL, Barry IG. Analysis of health surveys, vol. 323. Hoboken: Wiley; 2011. p. 160-80.
27.
Chowdhury SR, Machlin SR, Gwet KL. Methodology report# 33: sample designs of the medical expenditure panel survey household component, 1996–2006 and 2007–2016; 2020.
28.
29.
Luppino FS, de Wit LM, Bouvy PF, et al. Overweight, obesity, and depression: a systematic review and meta-analysis of longitudinal studies. Arch Gen Psychiatry. 2010;67(3):220–9.PubMedCrossRef
30.
Boutelle KN, Hannan P, Fulkerson JA, Crow SJ, Stice E. Obesity as a prospective predictor of depression in adolescent females. Health Psychol. 2010;29(3):293–8.PubMedPubMedCentralCrossRef
31.
Blaine B. Does depression cause obesity?: a meta-analysis of longitudinal studies of depression and weight control. J Health Psychol. 2008;13(8):1190–7.PubMedCrossRef
32.
Lee JS, Sheer JLO, Lopez N, Rosenbaum S. Coverage of obesity treatment: a state-by-state analysis of Medicaid and state insurance laws. Public Health Rep. 2010;125(4):596–604.PubMedPubMedCentralCrossRef
33.
34.
Fournier JC, DeRubeis RJ, Amsterdam J, Shelton RC, Hollon SD. Gains in employment status following antidepressant medication or cognitive therapy for depression. Br J Psychiatry. 2015;206(4):332–8.PubMedPubMedCentralCrossRef
35.
Zuelke AE, Luck T, Schroeter ML, Witte AV, Hinz A, Engel C, et al. The association between unemployment and depression–results from the population-based LIFE-adult-study. J Affect Disord. 2018;235:399–406.PubMedCrossRef
36.
Fergusson DM, McLeod GF, Horwood LJ. Unemployment and psychosocial outcomes to age 30: a fixed-effects regression analysis. Aust N Z J Psychiatry. 2014;48(8):735–42.PubMedCrossRef
37.
Konstantakopoulos G, Pikouli K, Ploumpidis D, et al. The impact of unemployment on mental health examined in a community mental health unit during the recent financial crisis in Greece. Psychiatrike = Psychiatriki. 2020;30(4):281–90.CrossRef
38.
Tsai AG, Williamson DF, Glick HA. Direct medical cost of overweight and obesity in the United States: a quantitative systematic review. Obes Rev. 2011;12(1):50–61.PubMedPubMedCentralCrossRef
39.
Gazmararian JA, Frisvold D, Zhang K, Koplan JP. Obesity is associated with an increase in pharmaceutical expenses among university employees. J Obes. 2015;2015:298698.PubMedPubMedCentralCrossRef
40.
Musich S, MacLeod S, Bhattarai GR, et al. The impact of obesity on health care utilization and expenditures in a Medicare supplement population. Gerontol Geriatr Med. 2016;2:2333721415622004.PubMedPubMedCentralCrossRef
41.
Preston SH, Stokes A. Obesity paradox. 2014;25(3):454–61.
42.
Decruyenaere A, Steen J, Colpaert K, Benoit DD, Decruyenaere J, Vansteelandt S. The obesity paradox in critically ill patients: a causal learning approach to a casual finding. Crit Care. 2020;24(1):485.PubMedPubMedCentralCrossRef
43.
Hansen L, Netterstrøm MK, Johansen NB, et al. Metabolically healthy obesity and ischemic heart disease: a 10-year follow-up of the Inter99 study. Clin Endocrinol Metab. 2017;102(6):1934–42.CrossRef
44.
Lavie CJ, De Schutter A, Milani RV. Healthy obese versus unhealthy lean: the obesity paradox. Nat Rev Endocrinol. 2015;11(1):55–62.PubMedCrossRef
45.
Oga EA, Eseyin OR. The obesity paradox and heart failure: a systematic review of a decade of evidence. J Obes. 2016;2016:e9040248.CrossRef
46.
Park J-H, Lee J, Ovbiagele B. Association of optimal combination drug treatment with obesity status among recent ischemic stroke patients: results of the vitamin intervention for stroke prevention (VISP) trial. J Stroke. 2017;19(2):213–21.PubMedPubMedCentralCrossRef
47.
Diercks DB, Roe MT, Mulgund J, et al. The obesity paradox in non–ST-segment elevation acute coronary syndromes: results from the can rapid risk stratification of unstable angina patients suppress ADverse outcomes with early implementation of the American College of Cardiology/American Heart Association guidelines quality improvement initiative. Am Heart J. 2006;152(1):140–8.PubMedCrossRef
48.
Piché ME, Tchernof A, Després JP. Obesity phenotypes, diabetes, and cardiovascular diseases. Circ Res. 2020;126:1477–500.PubMedCrossRef
49.
Sullivan M, Simon G, Spertus J, Russo J. Depression-related costs in heart failure care. Arch Intern Med. 2002;162(16):1860–6.PubMedCrossRef
50.
Zhdanava M, Kuvadia H, Joshi K, et al. Economic burden of treatment-resistant depression in privately insured U.S. patients with physical conditions. J Manag Care Spec Pharm. 2020;26(8):996–1007.PubMed
51.
Unützer J, Patrick DL, Simon G, Grembowski D, Walker E, Rutter C, et al. Depressive symptoms and the cost of health services in HMO patients aged 65 years and older. A 4-year prospective study. JAMA. 1997;277(20):1618–23.PubMedCrossRef
52.
Brüne M, Linnenkamp U, Andrich S, Jaffan-Kolb L, Claessen H, Dintsios CM, et al. Health Care Use and Costs in Individuals With Diabetes With and Without Comorbid Depression in Germany: Results of the Cross-sectional DiaDec Study. Diabetes care. 2021;44(2):407–15.PubMedCrossRef
53.
Alwhaibi M, Alhawassi TM. Humanistic and economic burden of depression and anxiety among adults with migraine: a systematic review. Depress Anxiety. 2020;37(11):1146–59.PubMedCrossRef
54.
König H, König HH, Konnopka A. The excess costs of depression: a systematic review and meta-analysis. Epidemiol Psychiatr Sci. 2020;29:e30.CrossRef
55.
Tanner JA, Hensel J, Davies PE, Brown LC, Dechairo BM, Mulsant BH. Economic burden of depression and associated resource use in Manitoba, Canada. Can J Psychiatry. 2020;65(5):338–46.PubMedCrossRef
56.
Gold SM, Köhler-Forsberg O, Moss-Morris R, et al. Comorbid depression in medical diseases. Nat Rev Dis Primers. 2020;6(1):1–22.CrossRef
57.
McGrady A, McGinnis R, Badenhop D, Bentle M, Rajput M. Effects of depression and anxiety on adherence to cardiac rehabilitation. J Cardiopulm Rehabil Prev. 2009;29(6):358–64.PubMedCrossRef
58.
Bautista LE, Vera-Cala LM, Colombo C, Smith P. Symptoms of depression and anxiety and adherence to antihypertensive medication. Am J Hypertens. 2012;25(4):505–11.PubMedPubMedCentralCrossRef
59.
Montesi L, El Ghoch M, Brodosi L, Calugi S, Marchesini G, Dalle GR. Long-term weight loss maintenance for obesity: a multidisciplinary approach. Diabetes Metab Syndr Obes. 2016;9:37–46.PubMedPubMedCentral
60.
Sharifi N, Mahdavi R, Ebrahimi-Mameghani M. Perceived barriers to weight loss programs for overweight or obese women. Health Promot Perspect. 2013;3(1):11–22.PubMedPubMedCentral
61.
Andersen I, Thielen K, Bech P, Nygaard E, Diderichsen F. Increasing prevalence of depression from 2000 to 2006. Scand J Public Health. 2011;39(8):857–63.PubMedCrossRef
62.
Compton WM, Conway KP, Stinson FS, Grant BF. Changes in the prevalence of major depression and comorbid substance use disorders in the United States between 1991-1992 and 2001-2002. Am J Psychiatry. 2006;163(12):2141–7.PubMedCrossRef
63.
Uher R, Payne JL, Pavlova B, Perlis RH. Major depressive disorder in DSM-5: implications for clinical practice and research of changes from DSM-IV. Depress Anxiety. 2014;31(6):459–71.PubMedCrossRef
64.
Patten SB, Williams JVA, Lavorato DH, Fiest KM, Bulloch AGM, Wang J. The prevalence of major depression is not changing. Can J Psychiatr. 2015;60(1):31–4.CrossRef
65.
Chen Y, Kelton CML, Jing Y, Guo JJ, Li X, Patel NC. Utilization, price, and spending trends for antidepressants in the US Medicaid program. Res Social Adm Pharm. 2008;4(3):244–57.PubMedCrossRef
Metadata
Title
Costs associated with depression and obesity among cardiovascular patients: medical expenditure panel survey analysis
Authors
Felipe Saia Tápias
Victor Henrique Oyamada Otani
Daniel Augusto Corrêa Vasques
Thais Zelia Santos Otani
Ricardo Riyoiti Uchida
Publication date
01-12-2021
Publisher
BioMed Central
Published in
BMC Health Services Research / Issue 1/2021
Electronic ISSN: 1472-6963
DOI
https://doi.org/10.1186/s12913-021-06428-x

Other articles of this Issue 1/2021

BMC Health Services Research 1/2021 Go to the issue

Research article

Context matters when implementing patient centred rehabilitation models for persons with cognitive impairment: a case study

Research article

District health managers perspectives of introducing a new service: a qualitative study of the community-based newborn care programme in Ethiopia

Research article

Oral cancer patient’s profile and time to treatment initiation in the public health system in Rio de Janeiro, Brazil

Research article

State medical malpractice laws and utilization of surgical treatment for rotator cuff tear and proximal humerus fracture: an observational cohort study

Research article

Prescribers’ perspectives on including reason for use information on prescriptions and medication labels: a qualitative thematic analysis

Research article

Beyond weight: examining the association of obesity with cardiometabolic related inpatient costs among Canadian adults using linked population based survey and hospital administrative data