Authors (including presenting author) :
Ho MTH(1)(2), Chan JKN(1), Lo HKY(1), Fang CZQ (1), Wong CSM(3), Lee KCK(1), Lai TT(4)(5)(6)(7), Ng APP(5), Chen KQ(5), Wong WCW(5), Chang WC(1)(8). Risk of mortality and complications in people with depressive disorder and diabetes mellitus: a 20-year population-based propensity score-matched cohort study
Affiliation :
(1)Department of Psychiatry, School of Clinical Medicine, LKS Faculty of Medicine, University of Hong Kong, Hong Kong, (2)Department of Psychiatry, United Christian Hospital, Hong Kong, (3)School of Public Health, LKS Faculty of Medicine, University of Hong Kong, Hong Kong, (4)Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, LKS Faculty of Medicine, University of Hong Kong, Hong Kong, (5)Department of Family Medicine and Primary Care, School of Clinical Medicine, LKS Faculty of Medicine, University of Hong Kong, Hong Kong, (6)Laboratory of Data Discovery for Health (D24H), Hong Kong Science Park, Sha Tin, Hong Kong, (7)Advanced Data Analytics for Medical Science (ADAMS) Limited, Hong Kong, (8)State Key Laboratory of Brain & Cognitive Sciences, University of Hong Kong, Hong Kong
Introduction :
People with depression have increased premature mortality and elevated prevalence of diabetes-mellitus compared to general population. However, risk of mortality and diabetes-related complications among patients with depression and co-occurring diabetes is under-studied.
Objectives :
We aimed to comprehensively examine the risk of mortality and complications in people with depression and co-occurring diabetes mellitus in Hong Kong.
Methodology :
This population-based propensity score-matched (1:10) cohort study identified 12,175 patients with pre-existing depression and incident-diabetes (depression-diabetes group) and 117,958 patients with incident-diabetes only (diabetes-only group) between 2002-2021 in Hong-Kong, using territory-wide medical-record database of public-healthcare services, to investigate whether depression increased the risk of overall mortality, complications and post-complication mortality in people with diabetes. Associations of depression with all-cause mortality, complication and post-complication all-cause mortality rates were examined by Cox proportional-hazards model. Complications were assessed by Diabetes-Complications-Severity-Index (DCSI). Associations of complications, in terms of DCSI scores (complication burden), specific types and two-way combinations of complications (complication patterns) with all-cause mortality rate in depression were also examined.
Result & Outcome :
Our results showed that depression-diabetes group exhibited increased all-cause mortality risk (adjusted hazards-ratio: 1.06 [95%CI: 1.02–1.10]) relative to diabetes-only group, particularly among men and older age group, with significantly higher rate of experiencing neuropathy (1.44 [1.27–1.62]) and metabolic complications (1.30 [1.09–1.56]) and lower likelihood of peripheral-vascular complications, retinopathy and nephropathy, albeit comparable macrovascular and microvascular complication rates. The mortality-rate-ratio for patients with depression and diabetes was significantly higher than patients with diabetes-only at a low level of complication burden. In conclusion, depression patients with co-occurring diabetes are at increased risk of excess mortality. Further research is warranted to improve diabetes-related outcomes and reduce mortality gap in this vulnerable population.
