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Depression and risk of hospitalisations and rehospitalisations for ambulatory care-sensitive conditions in Denmark: a population-based cohort study
  1. Dimitry S Davydow1,
  2. Morten Fenger-Grøn2,
  3. Anette Riisgaard Ribe2,
  4. Henrik Søndergaard Pedersen2,
  5. Anders Prior2,
  6. Peter Vedsted2,
  7. Jürgen Unützer1,
  8. Mogens Vestergaard2
  1. 1Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, USA
  2. 2Research Unit for General Practice, Department of Public Health, Aarhus University, Aarhus C, Denmark
  1. Correspondence to Dr Dimitry S Davydow; ddavydo1{at}u.washington.edu

Abstract

Objective Hospitalisations for ambulatory care-sensitive conditions (ACSCs), a group of chronic and acute illnesses considered not to require inpatient treatment if timely and appropriate ambulatory care is received, and early rehospitalisations are common and costly. We sought to determine whether individuals with depression are at increased risk of hospitalisations for ACSCs, and rehospitalisation for the same or another ACSC, within 30 days.

Design National, population-based cohort study.

Setting Denmark.

Participants 5 049 353 individuals ≥18 years of age between 1 January 2005 and 31 December 2013.

Measurements Depression was ascertained via psychiatrist diagnoses in the Danish Psychiatric Central Register or antidepressant prescription redemption from the Danish National Prescription Registry. Hospitalisations for ACSCs and rehospitalisations within 30 days were identified using the Danish National Patient Register.

Results Overall, individuals with depression were 2.35 times more likely to be hospitalised for an ACSC (95% CI 2.32 to 2.37) versus those without depression after adjusting for age, sex and calendar period, and 1.45 times more likely after adjusting for socioeconomic factors, comorbidities and primary care utilisation (95% CI 1.43 to 1.46). After adjusting for ACSC-predisposing comorbidity, depression was associated with significantly greater risk of hospitalisations for all chronic (eg, angina, diabetes complications, congestive heart failure exacerbation) and acute ACSCs (eg, pneumonia) compared to those without depression. Compared to those without depression, persons with depression were 1.21 times more likely to be rehospitalised within 30 days for the same ACSC (95% CI 1.18 to 1.24) and 1.19 times more likely to be rehospitalised within 30 days for a different ACSC (95% CI 1.15 to 1.23).

Conclusions Individuals with depression are at increased risk of hospitalisations for ACSCs, and once discharged are at elevated risk of rehospitalisations within 30 days for ACSCs.

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