Impact of Depression in Sickle Cell Disease Hospitalization-Related Outcomes: An Analysis of the National Inpatient Sample (NIS)

Objectives: This study aimed to analyze and discern the differences in demographics and inpatient outcomes (length of stay (LOS), total charges, disease severity, and mortality) between depressed versus non-depressed sickle cell disease (SCD) patients. : A retrospective analysis was conducted using the Nationwide Inpatient Sample (2010-2014). We identified 73,225 SCD hospitalizations and comorbid depression (6317, 8.6%) as the primary and the other diagnosis, respectively, using International Classification of Diseases (ICD)-9 codes. We used linear and logistic regression model to evaluate the changes in inpatient outcomes.

Results: Comorbid depression was more prevalent among middle-aged adults (11.5%), females (10.63%), and whites (12.43%). We did not find any association between income and comorbid depression among SCD patients. After adjusting for the demographic covariates, comorbid depression remained a significant risk factor for longer LOS (mean difference -1.16 days, 95% CI -1.30 to -1.03) and higher total charges (mean difference -USD5058, 95% CI -6261 to -3855) during hospitalization. SCD with comorbid depression was also significantly associated with a higher number of chronic conditions (mean difference -2.08, 95% CI -2.13 to -2.03) and 1.5 times (95% CI 1.39 to 1.63) higher odds of major severity of illness.

Conclusion: Comorbid depression was significantly associated with longer LOS, more severity of illness, and higher hospital charges. Healthcare providers caring for adults with SCD should consider screening for and treating comorbid depression to improve the health-related quality of life.