Anxiety Associated With Higher Healthcare Costs in Diabetes

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Identifying and treating anxiety may have an important role in controlling costs and healthcare use in diabetes.

Identifying and treating anxiety may have an important role in controlling costs and healthcare use in diabetes, according to study results published in Diabetes Care.

Previous studies have reported that mental health conditions are associated with increased hospitalization, healthcare costs, and higher likelihood of visits to the emergency department; however, data for patients with diabetes and anxiety are limited. The goal of the study was to investigate the association between anxiety and high-cost healthcare use in this population.

The researchers identified 143,573 adults with any electronic health record diagnosis of type 2 diabetes in the Kaiser Permanente Northern California Diabetes Registry from 2008 to 2011. They assessed for history of anxiety and depression, healthcare use and cost, demographics, comorbidities, and diabetes control and complications.

From 2008 to 2011, 12.9% of patients received ≥1 anxiety diagnosis. Compared with patients without, patients with anxiety were younger (mean age, 63.7±12.5 vs 62.1±12.6 years, respectively), more likely to be women (45.9% vs 63.2%, respectively), had a higher overall disease burden, higher body mass index (32.1 vs 33.1 kg/m2), and a higher prevalence of obesity (57% vs 62%). Diabetes control was mildly better in patients with anxiety (mean glycated hemoglobin, 7.3% vs 7.4%, respectively), but diabetes complications were more common.

Visits to the emergency department in 2012 were more common in patients with vs without anxiety (35.2% vs 23.6%; mean annual visits 0.75±1.7 vs 0.40±0.98; both P <.001). Average 2012 hospitalization costs were higher in patients with vs without anxiety ($5790 vs $4105; P <.001) and a higher percentage of patients with anxiety were classified as having high-cost status in 2012 (61.0% vs 42.1%; P <.001).

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A multivariable model adjusted for covariates, including depression, indicated that anxiety accounted for a 27% higher rate of visits to the emergency department (incidence rate ratio, 1.27; 95% CI, 1.21-1.34). Anxiety was also associated with increased risk of visiting the emergency department on a chronic, frequent basis (odds ratio [OR], 2.55; 95% CI 1.90-3.44).

Anxiety and depression were both significantly associated with having a high-cost status in 2012 (OR, 1.29; 95% CI, 1.23-1.36; and OR, 1.29; 95% CI, 1.24-1.34, respectively). However, anxiety was not related to total hospitalization costs in 2012.

The study had several limitations, including possible misclassification given that diagnoses were based on the electronic record codes and not clinical interviews; no account for medication regimen, which may affect psychological distress in diabetes; and no clear mechanism explaining emergency department visits.

“The current study, by demonstrating a unique link between anxiety and high-cost health care use in diabetes, provides an additional rationale for why this common human experience requires closer study,” concluded the researchers.

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Iturralde E, Chi FW, Grant RW, et al. Association of anxiety with high-cost health care use among individuals with type 2 diabetes [published online June 21, 2019]. Diabetes Care. doi:10.2337/dc18-1553