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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.

Original article
peer-reviewed

### Author Information

###### 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

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

###### 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.

##### Article Information

Published: September 03, 2017

###### DOI

10.7759/cureus.1648

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

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.

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.

###### Rikinkumar S. Patel, M.D.

Department of Psychiatry, Northwell Zucker Hillside Hospital

For correspondence:

###### 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:

###### 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