Background
Methods
Study design
Data source
Medicaid Analytic Extract (MAX) files
Area Health Resource Files (AHRF)
Identification of the T2DM and newly-diagnosed depression study cohort
Medicaid beneficiaries with T2DM
Medicaid beneficiaries with newly-diagnosed depression
Dependent variables
Total healthcare expenditures
T2DM-related healthcare expenditures
Independent variables
Key independent variables: depression treatment during the acute phase (need factor)
Antidepressant use
Coexisting chronic physical condition types (need factor)
Other independent variables
Statistical analyses
Adjusting for observed selection bias
Results
All | Dominant | Concordant only | Discordant only | Both concordant & discordant | Sig | |||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
N | % | N | % | N | % | N | % | N | % | |||
All | 5295 | 753 | 14.2 | 1444 | 27.3 | 834 | 15.8 | 2264 | 42.8 | *** | ||
Predisposing factors | ||||||||||||
Age | ||||||||||||
18–44 | 1335 | 25.2 | 122 | 9.1 | 426 | 31.9 | 256 | 19.2 | 531 | 39.8 | ||
45–54 | 1921 | 36.3 | 277 | 14.4 | 457 | 23.8 | 317 | 16.5 | 870 | 45.3 | ||
55–64 | 2039 | 38.5 | 354 | 17.4 | 561 | 27.5 | 261 | 12.8 | 863 | 42.3 | ||
Sex | *** | |||||||||||
Female | 3565 | 67.3 | 437 | 12.3 | 949 | 26.6 | 613 | 17.2 | 1566 | 43.9 | ||
Male | 1730 | 32.7 | 316 | 18.3 | 495 | 28.6 | 221 | 12.8 | 698 | 40.3 | ||
Race | ** | |||||||||||
White | 1420 | 26.8 | 203 | 14.3 | 369 | 26.0 | 251 | 17.7 | 597 | 42.0 | ||
AA | 1596 | 30.1 | 240 | 15.0 | 396 | 24.8 | 250 | 15.7 | 710 | 44.5 | ||
Other | 2279 | 43.0 | 310 | 13.6 | 679 | 29.8 | 333 | 14.6 | 957 | 42.0 | ||
Need factor | ||||||||||||
Other mental health conditions | *** | |||||||||||
Yes | 1877 | 35.4 | 349 | 18.6 | 476 | 25.4 | 294 | 15.7 | 758 | 40.4 | ||
No | 3418 | 64.6 | 404 | 11.8 | 968 | 28.3 | 540 | 15.8 | 1506 | 44.1 | ||
Enabling factors | ||||||||||||
Medicaid eligibility - poverty | ** | |||||||||||
Yes | 4620 | 87.3 | 1237 | 26.8 | 708 | 15.3 | 2014 | 43.6 | 661 | 14.3 | ||
No | 675 | 12.7 | 207 | 30.7 | 126 | 18.7 | 250 | 37.0 | 92 | 13.6 | ||
Medicaid eligibility - Medical Need | * | |||||||||||
Yes | 638 | 12.0 | 181 | 28.4 | 108 | 16.9 | 238 | 37.3 | 111 | 17.4 | ||
No | 4657 | 88.0 | 1263 | 27.1 | 726 | 15.6 | 2026 | 43.5 | 642 | 13.8 | ||
Medicaid eligibility - Waiver | ||||||||||||
Yes | 300 | 5.7 | 89 | 29.7 | 60 | 20.0 | 114 | 38.0 | 37 | 12.3 | ||
No | 4995 | 94.3 | 1355 | 27.1 | 774 | 15.5 | 2150 | 43.0 | 716 | 14.3 | ||
Personal health practices | ||||||||||||
Oral Antidiabetic Drugs (OADs) | *** | |||||||||||
1 | 1508 | 28.5 | 171 | 11.3 | 422 | 28.0 | 272 | 18.0 | 643 | 42.6 | ||
2 | 1238 | 23.4 | 144 | 11.6 | 353 | 28.5 | 214 | 17.3 | 527 | 42.6 | ||
3+ | 450 | 8.5 | 38 | 8.4 | 156 | 34.7 | 63 | 14.0 | 193 | 42.9 | ||
None | 2099 | 39.6 | 400 | 19.1 | 513 | 24.4 | 285 | 13.6 | 901 | 42.9 | ||
Insulin Use | *** | |||||||||||
Yes | 1827 | 34.5 | 277 | 15.2 | 512 | 28.0 | 148 | 8.1 | 890 | 48.7 | ||
No | 3468 | 65.5 | 476 | 13.7 | 932 | 26.9 | 686 | 19.8 | 1374 | 39.6 | ||
Polypharmacy | *** | |||||||||||
Yes | 1915 | 36.2 | 293 | 15.3 | 345 | 18.0 | 295 | 15.4 | 982 | 51.3 | ||
No | 3380 | 63.8 | 460 | 13.6 | 1099 | 32.5 | 539 | 15.9 | 1282 | 37.9 | ||
Inpatient hospitalization | *** | |||||||||||
Yes | 2604 | 49.2 | 534 | 20.5 | 532 | 20.4 | 232 | 8.9 | 1306 | 50.2 | ||
No | 2691 | 50.8 | 219 | 8.1 | 912 | 33.9 | 602 | 22.4 | 958 | 35.6 | ||
Outpatient visits | *** | |||||||||||
1st quartile | 1392 | 26.3 | 85 | 6.1 | 588 | 42.2 | 294 | 21.1 | 425 | 30.5 | ||
2nd quartile | 1221 | 23.1 | 139 | 11.4 | 352 | 28.8 | 215 | 17.6 | 515 | 42.2 | ||
3rd quartile | 1352 | 25.5 | 227 | 16.8 | 282 | 20.9 | 180 | 13.3 | 663 | 49.0 | ||
4th quartile | 1330 | 25.1 | 302 | 22.7 | 222 | 16.7 | 145 | 10.9 | 661 | 49.7 | ||
Mean ± SE | Mean ± SE | Mean ± SE | Mean ± SE | Mean ± SE | ||||||||
Number of T2DM-related office visits | 6.93 ± 0.13 | 7.98 ± 0.29 | 6.51 ± 0.29 | 5.44 ± 0.21 | 7.40 ± 0.19 | |||||||
Number of ER visits | 1.18 ± 0.03 | 1.65 ± 0.11 | 0.66 ± 0.04 | 0.78 ± 0.05 | 1.51 ± 0.05 | |||||||
External environment | ||||||||||||
State | *** | |||||||||||
Illinois | 1502 | 28.4 | 211 | 14.0 | 379 | 25.2 | 256 | 17.0 | 656 | 43.7 | ||
New York | 2550 | 48.2 | 402 | 15.8 | 725 | 28.4 | 405 | 15.9 | 1018 | 39.9 | ||
Texas | 1243 | 23.5 | 140 | 11.3 | 340 | 27.4 | 173 | 13.9 | 590 | 47.5 | ||
HPSA- mental health care | * | |||||||||||
Yes | 4405 | 83.2 | 651 | 14.8 | 1209 | 27.4 | 679 | 15.4 | 1866 | 42.4 | ||
No | 890 | 16.8 | 102 | 11.5 | 235 | 26.4 | 155 | 17.4 | 398 | 44.7 | ||
Metro | ** | |||||||||||
Yes | 4719 | 89.1 | 698 | 14.8 | 1291 | 27.4 | 730 | 15.5 | 2000 | 42.4 | ||
No | 576 | 10.9 | 55 | 9.5 | 153 | 26.6 | 104 | 18.1 | 264 | 45.8 | ||
CMHC | ||||||||||||
Yes | 2590 | 48.9 | 376 | 14.5 | 702 | 27.1 | 393 | 15.2 | 1119 | 43.2 | ||
No | 2705 | 51.1 | 377 | 13.9 | 742 | 27.4 | 441 | 16.3 | 1145 | 42.3 | ||
FQHC | ** | |||||||||||
Yes | 4365 | 82.4 | 651 | 14.9 | 1199 | 27.5 | 674 | 15.4 | 1841 | 42.2 | ||
No | 930 | 17.6 | 102 | 11.0 | 245 | 26.3 | 160 | 17.2 | 423 | 45.5 | ||
Median income | ** | |||||||||||
1st quartile | 1312 | 24.8 | 145 | 11.1 | 365 | 27.8 | 204 | 15.5 | 598 | 45.6 | ||
2nd quartile | 1415 | 26.7 | 199 | 14.1 | 378 | 26.7 | 246 | 17.4 | 592 | 41.8 | ||
3rd quartile | 1235 | 23.3 | 182 | 14.7 | 345 | 27.9 | 190 | 15.4 | 518 | 41.9 | ||
4th quartile | 1333 | 25.2 | 227 | 17.0 | 356 | 26.7 | 194 | 14.6 | 556 | 41.7 | ||
% with GT 4 years college education > 16%a | ** | |||||||||||
Yes | 4399 | 83.1 | 656 | 14.9 | 1197 | 27.2 | 704 | 16.0 | 1842 | 41.9 | ||
No | 896 | 16.9 | 97 | 10.8 | 247 | 27.6 | 130 | 14.5 | 422 | 47.1 | ||
% below poverty level GT 11.1%b | 753 | 1444 | 834 | 2264 | ||||||||
Yes | 4692 | 88.6 | 675 | 14.4 | 1284 | 27.4 | 732 | 15.6 | 2001 | 42.6 | ||
No | 603 | 11.4 | 78 | 12.9 | 160 | 26.5 | 102 | 16.9 | 263 | 43.6 | ||
Mean ± SE | Mean ± SE | Mean ± SE | Mean ± SE | Mean ± SE | ||||||||
Density of Social Workers | 3.01 ± 0.02 | 3.27 ± 0.06 | 3.02 ± 0.04 | 3.02 ± 0.06 | 2.91 ± 0.04 |
ALL expenditures | T2DM-related expenditures | |||||||
---|---|---|---|---|---|---|---|---|
Depression treatment | Change | 95 % CI | Sig | Change | 95 % CI | Sig | ||
Only antidepressants | −0.16 | −0.23 | −0.10 | *** | −0.10 | −0.18 | 0.00 | |
Only psychotherapy | −0.22 | −0.29 | −0.14 | *** | −0.28 | −0.36 | −0.19 | *** |
Antidepressants and psychotherapy | −0.28 | −0.36 | −0.19 | *** | −0.18 | −0.29 | −0.06 | ** |
ALL expenditures | T2DM-related expenditures | |||||||
---|---|---|---|---|---|---|---|---|
Depression treatment categories | Change | 95 % CI | Sig | Change | 95 % CI | Sig | ||
Dominant | ||||||||
Only antidepressants | −0.23 | −0.41 | 0.01 | −0.23 | −0.44 | 0.06 | ||
Only psychotherapy | −0.48 | −0.59 | −0.34 | *** | −0.41 | −0.55 | −0.23 | *** |
Antidepressants and Psychotherapy | −0.41 | −0.57 | −0.19 | ** | −0.24 | −0.48 | 0.1 | |
Concordant ONLY | ||||||||
Only antidepressants | −0.21 | −0.33 | −0.08 | ** | −0.05 | −0.22 | 0.16 | |
Only psychotherapy | −0.11 | −0.26 | 0.06 | −0.19 | −0.36 | 0.03 | ||
Antidepressants and Psychotherapy | −0.23 | −0.38 | −0.04 | * | −0.27 | −0.44 | −0.06 | * |
Discordant only | ||||||||
Only antidepressants | −0.18 | −0.31 | −0.02 | * | −0.09 | −0.26 | 0.13 | |
Only psychotherapy | −0.09 | −0.29 | 0.18 | −0.1 | −0.33 | 0.2 | ||
Antidepressants and Psychotherapy | −0.29 | −0.45 | −0.08 | * | −0.1 | −0.35 | 0.23 | |
Both concordant & discordant | ||||||||
Only antidepressants | −0.1 | −0.2 | 0.01 | −0.1 | −0.23 | 0.06 | ||
Only psychotherapy | −0.21 | −0.31 | −0.09 | *** | −0.34 | −0.45 | −0.19 | *** |
Antidepressants and Psychotherapy | −0.27 | −0.38 | −0.15 | *** | −0.1 | −0.28 | 0.14 |