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Original article
peer-reviewed

Impact of Depression on Hospitalization and Related Outcomes for Parkinson's Disease Patients: A Nationwide Inpatient Sample-Based Retrospective Study



Abstract

Background

Major Depressive Disorder (MDD) is a common comorbidity that significantly affects the quality of life and disease outcomes in Parkinson’s disease (PD) patients. No studies have been conducted to our knowledge to address the health care utilization and its outcomes in these patients. The aim of this study is to analyze and discern the differences in the hospitalization outcomes, comorbid conditions, and utilization of procedures in PD patients versus patients with comorbid MDD.

Methods

We used the Nationwide Inpatient Sample from the Healthcare Cost and Utilization Project from year’s 2010-2014. We identified PD and MDD as a primary and secondary diagnosis respectively using validated International Classification of Diseases, 9th Revision, and Clinical Modification codes. Pearson’s chi-square test and independent sample T-test were used for categorical data and continuous data, respectively. All statistical analysis was done by SPSS 22.0 in this study.

Results

Extensive analysis was performed on 63,912 patients with PD and 1445 patients with PD having MDD. Patients with comorbid depression had three times greater chances of disposition to acute care hospital (3.1% vs. 1.1%, p < 0.001). Median length of hospitalization was higher in Parkinson’s patients with depression (5.85 vs. 4.08 days; p < 0.001) though the median cost of hospitalization was low ($ 31,039 vs. $ 39,464; p < 0.001). This could be because therapeutic procedures performed during the hospitalization were lower in Parkinson’s patients with depression (0.53 vs. 0.89, p < 0.001). Utilization of Deep Brain Stimulation (DBS) was lower in Parkinson’s patients with depression (9.4% vs. 25.6%, p < 0.001). In­-hospital mortality was significantly higher in Parkinson’s patients with depression (1.4% vs. 1.1%; p < 0.001).

Conclusion

Our study establishes the negative impact of depression in PD with regards to hospitalization-related outcomes including the illness severity, comorbid conditions, risk of mortality, utilization of diagnostic and therapeutic procedures, the length of stay and disposition as compared to PD without depression.



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Original article
peer-reviewed

Impact of Depression on Hospitalization and Related Outcomes for Parkinson's Disease Patients: A Nationwide Inpatient Sample-Based Retrospective Study


Author Information

Rikinkumar S. Patel Corresponding Author

Department of Psychiatry, Northwell Zucker Hillside Hospital

Department of Global Public Health, Arcadia University

Ramkrishna Makani

Child and Adolescent Psychiatry, Children’s Hospital of Philadelphia

Zeeshan Mansuri

Psychiatry, Texas Tech University Health Science Center

Upenkumar Patel

Public Health, National University

Rupak Desai

Research Coordinator, Atlanta Veterans Affairs Medical Center

Amit Chopra

Psychiatry, Allegheny Health Network


Ethics Statement and Conflict of Interest Disclosures

Human subjects: All authors have confirmed that this study did not involve human participants or tissue. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.


Original article
peer-reviewed

Impact of Depression on Hospitalization and Related Outcomes for Parkinson's Disease Patients: A Nationwide Inpatient Sample-Based Retrospective Study


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Original article
peer-reviewed

Impact of Depression on Hospitalization and Related Outcomes for Parkinson's Disease Patients: A Nationwide Inpatient Sample-Based Retrospective Study

Rikinkumar S. Patel">Rikinkumar S. Patel , Ramkrishna Makani">Ramkrishna Makani, Zeeshan Mansuri">Zeeshan Mansuri, Upenkumar Patel">Upenkumar Patel, Rupak Desai">Rupak Desai, Amit Chopra">Amit Chopra

  • Author Information
    Rikinkumar S. Patel Corresponding Author

    Department of Psychiatry, Northwell Zucker Hillside Hospital

    Department of Global Public Health, Arcadia University

    Ramkrishna Makani

    Child and Adolescent Psychiatry, Children’s Hospital of Philadelphia

    Zeeshan Mansuri

    Psychiatry, Texas Tech University Health Science Center

    Upenkumar Patel

    Public Health, National University

    Rupak Desai

    Research Coordinator, Atlanta Veterans Affairs Medical Center

    Amit Chopra

    Psychiatry, Allegheny Health Network


    Ethics Statement and Conflict of Interest Disclosures

    Human subjects: All authors have confirmed that this study did not involve human participants or tissue. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

    Acknowledgements


    Article Information

    Published: September 03, 2017

    DOI

    10.7759/cureus.1648

    Cite this article as:

    Patel R S, Makani R, Mansuri Z, et al. (September 03, 2017) Impact of Depression on Hospitalization and Related Outcomes for Parkinson's Disease Patients: A Nationwide Inpatient Sample-Based Retrospective Study. Cureus 9(9): e1648. doi:10.7759/cureus.1648

    Publication history

    Received by Cureus: August 05, 2017
    Peer review began: August 22, 2017
    Peer review concluded: August 28, 2017
    Published: September 03, 2017

    Copyright

    © Copyright 2017
    Patel et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 3.0., which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

    License

    This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Abstract

Background

Major Depressive Disorder (MDD) is a common comorbidity that significantly affects the quality of life and disease outcomes in Parkinson’s disease (PD) patients. No studies have been conducted to our knowledge to address the health care utilization and its outcomes in these patients. The aim of this study is to analyze and discern the differences in the hospitalization outcomes, comorbid conditions, and utilization of procedures in PD patients versus patients with comorbid MDD.

Methods

We used the Nationwide Inpatient Sample from the Healthcare Cost and Utilization Project from year’s 2010-2014. We identified PD and MDD as a primary and secondary diagnosis respectively using validated International Classification of Diseases, 9th Revision, and Clinical Modification codes. Pearson’s chi-square test and independent sample T-test were used for categorical data and continuous data, respectively. All statistical analysis was done by SPSS 22.0 in this study.

Results

Extensive analysis was performed on 63,912 patients with PD and 1445 patients with PD having MDD. Patients with comorbid depression had three times greater chances of disposition to acute care hospital (3.1% vs. 1.1%, p < 0.001). Median length of hospitalization was higher in Parkinson’s patients with depression (5.85 vs. 4.08 days; p < 0.001) though the median cost of hospitalization was low ($ 31,039 vs. $ 39,464; p < 0.001). This could be because therapeutic procedures performed during the hospitalization were lower in Parkinson’s patients with depression (0.53 vs. 0.89, p < 0.001). Utilization of Deep Brain Stimulation (DBS) was lower in Parkinson’s patients with depression (9.4% vs. 25.6%, p < 0.001). In­-hospital mortality was significantly higher in Parkinson’s patients with depression (1.4% vs. 1.1%; p < 0.001).

Conclusion

Our study establishes the negative impact of depression in PD with regards to hospitalization-related outcomes including the illness severity, comorbid conditions, risk of mortality, utilization of diagnostic and therapeutic procedures, the length of stay and disposition as compared to PD without depression.



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Rikinkumar S. Patel, M.D.

Department of Psychiatry, Northwell Zucker Hillside Hospital

For correspondence:
rpatel_09@arcadia.edu

Ramkrishna Makani

Child and Adolescent Psychiatry, Children’s Hospital of Philadelphia

Zeeshan Mansuri

Psychiatry, Texas Tech University Health Science Center

Upenkumar Patel, M.B.B.S., M.P.H

Public Health, National University

Rupak Desai

Research Coordinator, Atlanta Veterans Affairs Medical Center

Amit Chopra

Psychiatry, Allegheny Health Network

Rikinkumar S. Patel, M.D.

Department of Psychiatry, Northwell Zucker Hillside Hospital

For correspondence:
rpatel_09@arcadia.edu

Ramkrishna Makani

Child and Adolescent Psychiatry, Children’s Hospital of Philadelphia

Zeeshan Mansuri

Psychiatry, Texas Tech University Health Science Center

Upenkumar Patel, M.B.B.S., M.P.H

Public Health, National University

Rupak Desai

Research Coordinator, Atlanta Veterans Affairs Medical Center

Amit Chopra

Psychiatry, Allegheny Health Network