Relation between inflammatory bowel disease, depression, and inpatient outcomes in the United States
Hassam Ali1, Rahul Pamarthy1, Nicole Leigh Bolick2
1Department of Internal Medicine, East Carolina University/Vidant Medical Center, Greenville, North Carolina.
Insights
Depression complicates inflammatory bowel disease (IBD) care, increasing hospital length of stay for ulcerative colitis (UC) and Crohn's disease (CD) patients. However, depression was linked to lower overall inpatient costs in IBD.
Area of Science:
- Gastroenterology
- Psychiatry
- Health Services Research
Background:
- The interplay between inflammatory bowel disease (IBD) and depression is complex and understudied in inpatient settings.
- Previous research has not specifically examined the impact of depression on ulcerative colitis (UC) and Crohn's disease (CD) within the US inpatient population.
Purpose of the Study:
- To investigate the effect of depression on hospital length of stay (LOS), costs, and mortality in hospitalized patients with UC and CD.
- To compare the outcomes between UC and CD patients with and without depression.
Main Methods:
- Retrospective analysis of inpatient data from the National Inpatient Sample database (2016-2019).
- Inclusion criteria: patients admitted with UC or CD.
- Primary outcomes: LOS, costs, and mortality. Secondary outcomes: comparison between UC and CD.
Main Results:
- Depression was present in 13.4% of UC patients and 14.9% of CD patients.
- Patients with depression experienced longer LOS in both UC and CD cohorts (P < 0.001).
- Depression was associated with lower inpatient hospital costs across IBD (P < 0.001), but higher costs in CD vs. UC subgroups ($17,974 difference, P < 0.001).
- Depression did not significantly increase mortality but did increase LOS, with a more pronounced effect in CD patients compared to UC patients.
Conclusions:
- Depression significantly increases hospital LOS for IBD patients, particularly those with Crohn's disease.
- While depression is linked to increased LOS, it is paradoxically associated with lower overall inpatient costs for IBD patients.
- White women exhibit a higher prevalence of depression within the IBD population.
Abstract:
The relationship between inflammatory bowel disease (IBD) and depression is complicated. The effect of depression on ulcerative colitis (UC) and Crohn's disease (CD) among the inpatient US population has not previously been studied. We retrospectively analyzed patients admitted with UC and CD from 2016 to 2019 using the National Inpatient Sample database. Our primary outcome was the effect of depression on hospital length of stay (LOS), costs, and mortality. Secondary outcomes included the comparison between UC and CD cases. In the UC population, 13.4% had depression, compared to 14.9% in the CD population. LOS was longer in UC and CD patients with depression (P < 0.001). Subgroup analysis revealed that LOS was longer in CD patients than UC patients in the depressed cohort (P < 0.001). Inpatient hospital costs were lower in IBD patients with depression (P < 0.001). Subgroup analysis revealed that hospital cost was $17,974 higher in CD patients than UC patients (P < 0.001). Depression did not increase mortality in the IBD population but increased LOS, with a greater impact on CD than UC. White women were found to have an increased prevalence of depression in the IBD population.
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