Chest
Volume 149, Issue 4, April 2016, Pages 905-915
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Original Research: COPD
Association of Psychological Disorders With 30-Day Readmission Rates in Patients With COPD

This work was previously presented as a poster presentation at the 2015 American Thoracic Society International Conference, May 15-20, 2015, Denver, CO.
https://doi.org/10.1378/chest.15-0449Get rights and content

Background

There is a growing understanding of the prevalence and impact of psychological disorders on COPD. However, the role of these disorders in early readmission is unclear.

Methods

We analyzed data from 5% fee-for-service Medicare beneficiaries diagnosed with COPD (International Classification of Diseases, Ninth Revision code, 491.xx, 492.xx, 493.xx, and 496.xx) between 2001 and 2011 who were hospitalized with a primary discharge diagnosis of COPD or a primary discharge diagnosis of respiratory failure (518.xx and 799.1) with secondary diagnosis of COPD. We hypothesized that such psychological disorders as depression, anxiety, psychosis, alcohol abuse, and drug abuse are independently associated with an increased risk of 30-day readmission in patients hospitalized for COPD.

Results

Between 2001 and 2011, 135,498 hospitalizations occurred for COPD in 80,088 fee-for-service Medicare beneficiaries. Of these, 30,218 (22.30%) patients had one or more psychological disorders. In multivariate analyses, odds of 30-day readmission were higher in patients with COPD who had depression (OR, 1.34; 95% CI, 1.29-1.39), anxiety (OR, 1.43; 95% CI, 1.37-1.50), psychosis (OR, 1.18; 95% CI, 1.10-1.27), alcohol abuse (OR, 1.30; 95% CI, 1.15-1.47), and drug abuse (OR, 1.29; 95% CI, 1.11-1.50) compared with those who did not have these disorders. These psychological disorders increased amount of variation in 30-day readmission attributed to patient characteristics by 37%.

Conclusions

Psychological disorders like depression, anxiety, psychosis, alcohol abuse, and drug abuse are independently associated with higher all-cause 30-day readmission rates for Medicare beneficiaries with COPD.

Section snippets

Data Source

This study used files from the 5% Medicare sample from 2001 to 2011 provided by Research Data Assistance Center (ResDAC).23 The CMS select a random sample of 5% Medicare beneficiaries based on the eighth and ninth digits (05, 20, 45, 70, and 95) of their health insurance claim number; this is the standard dataset available for research purposes and has been shown to be representative of the whole cohort. The study was approved by the University of Texas Medical Branch institutional review board

Results

Between 2001 and 2011, 135,498 hospitalizations occurred for COPD in 80,088 fee-for-service Medicare patients. Of these, 30,218 (22.30%) patients had one or more coexisting psychological disorders, with highest prevalence in most recent years, as noted in earlier studies.31, 32 Table 1 shows the baseline characteristics of the cohort stratified according to presence of these psychological disorders. Relative to patients with COPD without coexisting psychological disorders, patients with these

Discussion

In this retrospective cohort study, we found that psychological disorders such as depression, anxiety, psychosis, alcohol abuse, and drug abuse contribute significantly to the 30-day readmission rate for elderly patients with COPD. Similar to prior studies, we found that patients with COPD with low socioeconomic status,33, 34 psychosis,35 and alcohol abuse36 had higher readmission rates. This is likely related to limited capacity of these patients to meet the workload of disease burden, poor

Acknowledgments

Author contributions: G. Singh had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis, including and especially any adverse effects. G. Singh served as principal author. W. Z., Y.-F. K., and G. Sharma contributed to the conception, study design, analysis, interpretation of results, drafting of manuscript, and final approval of the manuscript.

Financial/nonfinancial disclosures: G. Sharma served on the advisory

References (73)

  • C. Vögele et al.

    Mental disorders in chronic obstructive pulmonary disease (COPD)

    Respir Med

    (2008)
  • J. Maurer et al.

    Anxiety and depression in COPD: current understanding, unanswered questions, and research needs

    Chest

    (2008)
  • O.P. Almeida et al.

    Depression and smoking amongst older general practice patients

    J Affect Disord

    (2005)
  • M.C. Moore et al.

    The catastrophic misinterpretation of physiological distress

    Behav Res Ther

    (1999)
  • C.C. Greene et al.

    The association between alcohol consumption and risk of COPD exacerbation in a veteran population

    Chest

    (2008)
  • S. Borson et al.

    Improvement in mood, physical symptoms, and function with nortriptyline for depression in patients with chronic obstructive pulmonary disease

    Psychosomatics

    (1992)
  • G.S. Alexopoulos et al.

    Outcomes of depressed patients undergoing inpatient pulmonary rehabilitation

    Am J Geriatr Psychiatry

    (2006)
  • A. von Leupoldt et al.

    The impact of anxiety and depression on outcomes of pulmonary rehabilitation in patients with COPD

    Chest

    (2011)
  • P.A. Coventry et al.

    Comprehensive pulmonary rehabilitation for anxiety and depression in adults with chronic obstructive pulmonary disease: systematic review and meta-analysis

    J Psychosom Res

    (2007)
  • D.V. de Godoy et al.

    A randomized controlled trial of the effect of psychotherapy on anxiety and depression in chronic obstructive pulmonary disease

    Arch Phys Med Rehabil

    (2003)
  • A.G. Au et al.

    Predicting the risk of unplanned readmission or death within 30 days of discharge after a heart failure hospitalization

    Am Heart J

    (2012)
  • B.D. Stein et al.

    The validity of International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis codes for identifying patients hospitalized for COPD exacerbations

    Chest

    (2012)
  • T.-P. Ng et al.

    Depressive symptoms and chronic obstructive pulmonary disease: effect on mortality, hospital readmission, symptom burden, functional status, and quality of life

    Arch Intern Med

    (2007)
  • V.S. Fan et al.

    Sex, depression, and risk of hospitalization and mortality in chronic obstructive pulmonary disease

    Arch Intern Med

    (2007)
  • A.M. Yohannes et al.

    Mood disorders in elderly patients with chronic obstructive pulmonary disease

    Rev Clin Gerontol

    (2000)
  • R.L. Mikkelsen et al.

    Anxiety and depression in patients with chronic obstructive pulmonary disease (COPD). A review

    Nord J Psychiatry

    (2004)
  • A.M. Yohannes et al.

    Depression and anxiety in chronic heart failure and chronic obstructive pulmonary disease: prevalence, relevance, clinical implications and management principles

    Int J Geriatr Psychiatry

    (2010)
  • C. Laurin et al.

    Chronic obstructive pulmonary disease patients with psychiatric disorders are at greater risk of exacerbations

    Psychosom Med

    (2009)
  • A.A. Dalal et al.

    Clinical and economic burden of depression/anxiety in chronic obstructive pulmonary disease patients within a managed care population

    COPD

    (2011)
  • W. Xu et al.

    Independent effect of depression and anxiety on chronic obstructive pulmonary disease exacerbations and hospitalizations

    Am J Respir Crit Care Med

    (2008)
  • J.H. Jennings et al.

    The association between depressive symptoms and acute exacerbations of COPD

    Lung

    (2009)
  • J. Qian et al.

    Effects of depression diagnosis and antidepressant treatment on mortality in Medicare beneficiaries with chronic obstructive pulmonary disease

    J Am Geriatr Soc

    (2013)
  • S.F. Jencks et al.

    Rehospitalizations among patients in the Medicare fee-for-service program

    N Engl J Med

    (2009)
  • Elixhauser A, Steiner C. Readmissions to US hospitals by diagnosis,...
  • J.R. Hurst et al.

    Susceptibility to exacerbation in chronic obstructive pulmonary disease

    N Engl J Med

    (2010)
  • C.L. Baker et al.

    Risk assessment of readmissions following an initial COPD-related hospitalization

    Int J Chron Obstruct Pulmon Dis

    (2013)
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    FUNDING/SUPPORT: This work was supported by the Agency for Healthcare Research and Quality [Grant R01-HS020642], the Patient-Centered Outcomes Research Institute [Grant R24HS022134], the Clinical and Translational Science Award [Grant UL1TR000071] from the National Center for Advancing Translational Sciences, and the Claude D. Pepper Older Americans Independence Center [Grant 5P30-AG024832].

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