Laura K Stein, Alana Kornspun, John Erdman, Mandip S Dhamoon
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We performed adjusted Cox regression to calculate hazard ratio (HR) for readmission for depression and SA up to 1 year following IS versus MI. Analyses were stratified by discharge home versus elsewhere.</p><p><strong>Results: </strong>Weighted depression readmission rates were higher at 30, 60, and 90 days in patients with IS versus MI (0.04%, 0.09%, 0.12% vs. 0.03%, 0.05%, 0.07%, respectively). There was no significant difference in SA readmissions between groups. The adjusted HR for readmission due to depression was 1.49 for IS versus MI (95% CI 1.25-1.79, p < 0.0001). History of depression (HR 3.70 [3.07-4.46]), alcoholism (2.04 [1.34-3.09]), and smoking (1.38 [1.15-1.64]) were associated with increased risk of depression readmission. Age >70 years (0.46 [0.37-0.56]) and discharge home (0.69 [0.57-0.83]) were associated with reduced hazards of readmission due to depression.</p><p><strong>Conclusions: </strong>IS was associated with greater hazard of readmission due to depression compared to MI. Patients with a history of depression, smoking, and alcoholism were more likely to be readmitted with depression, while advanced age and discharge home were protective. It is unclear to what extent differences in type of ischemic tissue damage and disability contribute, and further investigation is warranted.</p>","PeriodicalId":45709,"journal":{"name":"Cerebrovascular Diseases Extra","volume":null,"pages":null},"PeriodicalIF":2.0000,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000509454","citationCount":"3","resultStr":"{\"title\":\"Readmissions for Depression and Suicide Attempt following Stroke and Myocardial Infarction.\",\"authors\":\"Laura K Stein, Alana Kornspun, John Erdman, Mandip S Dhamoon\",\"doi\":\"10.1159/000509454\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background and purpose: </strong>Rates of depression after ischemic stroke (IS) and myocardial infarction (MI) are significantly higher than in the general population and associated with morbidity and mortality. There is a lack of nationally representative data comparing depression and suicide attempt (SA) after these distinct ischemic vascular events.</p><p><strong>Methods: </strong>The 2013 Nationwide Readmissions Database contains >14 million US admissions for all payers and the uninsured. Using International Classification of Disease, 9th Revision, Clinical Modification Codes, we identified index admission with IS (n = 434,495) or MI (n = 539,550) and readmission for depression or SA. We calculated weighted frequencies of readmission. We performed adjusted Cox regression to calculate hazard ratio (HR) for readmission for depression and SA up to 1 year following IS versus MI. Analyses were stratified by discharge home versus elsewhere.</p><p><strong>Results: </strong>Weighted depression readmission rates were higher at 30, 60, and 90 days in patients with IS versus MI (0.04%, 0.09%, 0.12% vs. 0.03%, 0.05%, 0.07%, respectively). There was no significant difference in SA readmissions between groups. The adjusted HR for readmission due to depression was 1.49 for IS versus MI (95% CI 1.25-1.79, p < 0.0001). History of depression (HR 3.70 [3.07-4.46]), alcoholism (2.04 [1.34-3.09]), and smoking (1.38 [1.15-1.64]) were associated with increased risk of depression readmission. Age >70 years (0.46 [0.37-0.56]) and discharge home (0.69 [0.57-0.83]) were associated with reduced hazards of readmission due to depression.</p><p><strong>Conclusions: </strong>IS was associated with greater hazard of readmission due to depression compared to MI. Patients with a history of depression, smoking, and alcoholism were more likely to be readmitted with depression, while advanced age and discharge home were protective. It is unclear to what extent differences in type of ischemic tissue damage and disability contribute, and further investigation is warranted.</p>\",\"PeriodicalId\":45709,\"journal\":{\"name\":\"Cerebrovascular Diseases Extra\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":2.0000,\"publicationDate\":\"2020-01-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://sci-hub-pdf.com/10.1159/000509454\",\"citationCount\":\"3\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Cerebrovascular Diseases Extra\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.1159/000509454\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2020/8/27 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q3\",\"JCRName\":\"PERIPHERAL VASCULAR DISEASE\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Cerebrovascular Diseases Extra","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1159/000509454","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2020/8/27 0:00:00","PubModel":"Epub","JCR":"Q3","JCRName":"PERIPHERAL VASCULAR DISEASE","Score":null,"Total":0}
引用次数: 3
摘要
背景和目的:缺血性卒中(IS)和心肌梗死(MI)后的抑郁率明显高于普通人群，并与发病率和死亡率相关。在这些不同的缺血性血管事件后，缺乏比较抑郁和自杀企图(SA)的全国代表性数据。方法:2013年全国再入院数据库包含了超过1400万美国所有付款人和未参保人的入院情况。使用国际疾病分类第9版临床修改代码，我们确定了IS (n = 434,495)或MI (n = 539,550)的入院指标和抑郁症或SA的再入院指标。我们计算了再入院的加权频率。我们进行了校正Cox回归，计算IS与MI后1年内抑郁症和SA再入院的风险比(HR)。分析按出院家与其他地方进行分层。结果:IS患者在30,60和90天的加权抑郁症再入院率高于MI患者(分别为0.04%，0.09%，0.12% vs. 0.03%， 0.05%， 0.07%)。两组间SA再入院率无显著差异。IS与MI因抑郁症再入院的调整HR为1.49 (95% CI 1.25-1.79, p < 0.0001)。抑郁史(HR 3.70[3.07-4.46])、酗酒史(HR 2.04[1.34-3.09])和吸烟史(HR 1.38[1.15-1.64])与抑郁症再入院风险增加相关。年龄>70岁(0.46[0.37-0.56])和出院(0.69[0.57-0.83])与抑郁症再入院风险降低相关。结论:与心肌梗死相比，IS与更大的抑郁症再入院风险相关。有抑郁症、吸烟和酗酒史的患者更有可能因抑郁症再入院，而高龄和出院家庭则具有保护作用。目前尚不清楚缺血性组织损伤和残疾类型的差异在多大程度上起作用，需要进一步的研究。
Readmissions for Depression and Suicide Attempt following Stroke and Myocardial Infarction.
Background and purpose: Rates of depression after ischemic stroke (IS) and myocardial infarction (MI) are significantly higher than in the general population and associated with morbidity and mortality. There is a lack of nationally representative data comparing depression and suicide attempt (SA) after these distinct ischemic vascular events.
Methods: The 2013 Nationwide Readmissions Database contains >14 million US admissions for all payers and the uninsured. Using International Classification of Disease, 9th Revision, Clinical Modification Codes, we identified index admission with IS (n = 434,495) or MI (n = 539,550) and readmission for depression or SA. We calculated weighted frequencies of readmission. We performed adjusted Cox regression to calculate hazard ratio (HR) for readmission for depression and SA up to 1 year following IS versus MI. Analyses were stratified by discharge home versus elsewhere.
Results: Weighted depression readmission rates were higher at 30, 60, and 90 days in patients with IS versus MI (0.04%, 0.09%, 0.12% vs. 0.03%, 0.05%, 0.07%, respectively). There was no significant difference in SA readmissions between groups. The adjusted HR for readmission due to depression was 1.49 for IS versus MI (95% CI 1.25-1.79, p < 0.0001). History of depression (HR 3.70 [3.07-4.46]), alcoholism (2.04 [1.34-3.09]), and smoking (1.38 [1.15-1.64]) were associated with increased risk of depression readmission. Age >70 years (0.46 [0.37-0.56]) and discharge home (0.69 [0.57-0.83]) were associated with reduced hazards of readmission due to depression.
Conclusions: IS was associated with greater hazard of readmission due to depression compared to MI. Patients with a history of depression, smoking, and alcoholism were more likely to be readmitted with depression, while advanced age and discharge home were protective. It is unclear to what extent differences in type of ischemic tissue damage and disability contribute, and further investigation is warranted.
期刊介绍：
This open access and online-only journal publishes original articles covering the entire spectrum of stroke and cerebrovascular research, drawing from a variety of specialties such as neurology, internal medicine, surgery, radiology, epidemiology, cardiology, hematology, psychology and rehabilitation. Offering an international forum, it meets the growing need for sophisticated, up-to-date scientific information on clinical data, diagnostic testing, and therapeutic issues. The journal publishes original contributions, reviews of selected topics as well as clinical investigative studies. All aspects related to clinical advances are considered, while purely experimental work appears only if directly relevant to clinical issues. Cerebrovascular Diseases Extra provides additional contents based on reviewed and accepted submissions to the main journal Cerebrovascular Diseases.
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