OBJECTIVES

Approximately 33% of stroke survivors suffer depression and depression is associated with disability, poor quality of life and mortality. However, assessments of association with healthcare expenditures among stroke survivors were not found. We examined association between depression and healthcare expenditures among stroke survivors.

METHODS

A retrospective cohort study was conducted using pooled data of 2-year panels from the 2012 through 2016 Medical Expenditure Panel Survey. The panel year-one was used to identify stroke survivors, depression diagnosis and baseline characteristics. The panel year-two was the follow-up period. Inclusion criteria were being 18 years old or older, and stroke diagnosis. Exclusion criteria were institutionalization or death. Stroke was identified based on having ICD-9 diagnosis codes (430 - 438), or ever being told by a healthcare provider they had a stroke. Depression was identified based on ICD-9 diagnosis codes (296, 300, 309 or 311) only, since there was no self-report of depression variable in the data. In-patient, out-patient, emergency room, prescription medicines and total healthcare expenditures were examined in panel year-two. Associations between depression and each expenditure category were estimated using a two-part Logit GLM model in STATA, to account for excess zeros and adjusting for age, sex, race, education, marital status, employment status, insurance type, region, income, perceived health, smoking status and comorbidity with an alpha of 0.05 for significance.

RESULTS

The final sample (unweighted N = 1,498) was mostly female (58%) and non-Hispanic whites (48%); and 30% (95% CI = 27.9% - 32.6%) had depression. The mean (± standard deviation) age was 64 (± 14.4) years. Depression was associated with an average increment of $3,275 (95% CI = $1,157- $5,393) in prescription expenditures (p=0.003). Depression was not associated with in-patient, out-patient, emergency room, or total healthcare expenditures.

CONCLUSIONS

Depression in stroke survivors was associated with increased prescription expenditure, but not other expenditures.