Age- and gender-specific mortality risk profiles for depressive outpatients with major chronic medical diseases

BACKGROUND: As leading causes of death, chronic medical diseases, particularly common cardiovascular diseases, are associated with depression. The combination of depression and chronic medical disease in turn is linked with poorer health and premature death. Despite numerous studies on mortality in people with depression and chronic medical disease, the effects of age and gender were not consistently considered. To appropriately estimate mortality in the clinical setting, we aimed to analyse age- and gender-specific mortality profiles in outpatients with depression and chronic medical disease by considering depression severity.

METHODS: We examined data from N=327,018 outpatients with depression aged 18 years and older (mean=60 years), which we obtained from German electronic health-insurance claims data covering the years 2007-2010. We considered major chronic medical disease groups: cardiovascular diseases, diabetes, diseases of the respiratory system and cancer. To analyse both adjusted mortality risk and rates over one year in a comprehensive manner, we calculated General Estimation Equation (GEE) Poisson models for binary data.

RESULTS: The mortality risk increased with age and was higher for males. Especially patients below 60 years of age with cancer or diabetes had an increased mortality risk, but not patients with cardiovascular disease. Mortality was comparably increased in patients with severe depression, diabetes or respiratory disease.

LIMITATIONS: We did not have data from a control group without depression.

CONCLUSIONS: Notably, not cardiovascular diseases but cancer and, to a lesser extent, diabetes, both in younger patients, respiratory diseases and severity of depression require particular attention in outpatient care to reduce mortality.