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Danish adults with depression have higher risk for hospitalization for ambulatory care-sensitive conditions

Results from a national, population-based cohort study indicate an increased risk for hospitalization for ambulatory care-sensitive conditions and rehospitalization for these conditions within 30 days among adults with depression.

“Depression is highly prevalent worldwide, and is independently associated with more chronic disease sequelae, greater healthcare costs and increased mortality. Importantly, depression is amenable to treatment and could be a potentially modifiable risk factor for [ambulatory care-sensitive conditions]-related hospitalizations. Depression may increase hospitalizations for [ambulatory care-sensitive conditions] through factors such as reduced adherence to chronic disease treatments and reduced self-care,” Dimitry S Davydow, MD, MPH, of University of Washington, Seattle, and colleagues wrote.

To assess if individuals with depression had an increased risk for hospitalizations for ambulatory care-sensitive conditions and rehospitalization within 30 days, researchers evaluated Danish Civil Registration system data for 5,049,353 individuals age 18 years and older.

Overall, individuals with depression were 2.35 (95% CI, 2.32-2.37) times more likely to be hospitalized for ambulatory care-sensitive conditions compared with those without depression, when adjusting for age, sex and calendar period.

When adjusting for socioeconomic factors, comorbidities, and primary care utilization, individuals with depression were 1.45 (95% CI, 1.43-1.46) times more likely to be hospitalization for an ambulatory care-sensitive condition.

Depression was associated with a significantly greater risk for hospitalization for all chronic (eg, angina, diabetes complications, congestive heart failure exacerbation) and acute ambulatory care-sensitive conditions (eg, pneumonia), when adjusting for comorbidities that predisposed individuals to ambulatory care-sensitive conditions.

Adults with depression were 1.21(95% CI, 1.18-1.24) times more likely to be rehospitalized within 30 days for the same condition and 1.19 (95% CI, 1.15-1.23) times more likely to be rehospitalized within 30 days for a different condition, compared with adults without depression.

“This study has important implications for development of interventions to prevent costly [ambulatory care-sensitive conditions]-related hospitalizations and rehospitalizations,” Davydow and colleagues wrote. “A potential explanation for our findings is that depressed individuals may not receive timely and/or appropriate ambulatory care for chronic diseases such as diabetes or cardiovascular disease as well as acute diseases such as pneumonia or [urinary tract infections]. Yet, we found that depression was independently associated with increased risk of hospitalizations for these conditions even in a country, Denmark, with universal access to primary care. Therefore, it could be reasonable to conclude that simply increasing access to primary care may not ameliorate these problems.” – by Amanda Oldt

Disclosure: The researchers report no relevant financial disclosures.