Incident Depression Among Medicare Beneficiaries with Disabilities and HIV

Objective: Despite disproportionally high prevalence of HIV and depression in persons with disabilities, no data have been published on the incidence and correlates of depression in Medicare beneficiaries with disabilities. We assessed the effect of HIV infection on developing depression in this population.

Design: We conducted a retrospective matched cohort study using a 5% sample of Medicare beneficiaries who qualified for disability coverage (1996-2015).

Methods: Beneficiaries with incident ( n  = 2438) and prevalent ( n  = 5758) HIV were individually matched with beneficiaries without HIV (HIV-, n  = 20 778). Fine-Gray models with death as a competing risk were used to assess the effect of HIV status, age, and cohort period on developing depression by sex strata.

Results: Beneficiaries with HIV had a higher risk of developing depression within 5 years ( P  < 0.0001). Sex differences were observed ( P  < 0.0001), with higher subdistribution hazard ratios (sHR) in males with HIV compared with controls. The risk decreased with age ( P  < 0.0001) and increased in recent years ( P  < 0.0001). There were significant age-HIV ( P  = 0.004) and period-HIV ( P  = 0.006) interactions among male individuals, but not female individuals. The sHR was also higher within the first year of follow-up among male individuals, especially those with incident HIV.

Conclusion: Medicare enrollees with disabilities and HIV had an increased risk of developing depression compared to those without HIV, especially among males and within the first year of HIV diagnosis. The HIV-depression association varied by sex, age, and cohort period. Our findings may help guide screening and comprehensive management of depression among subgroups in this vulnerable population.