Depression and Healthcare Cost Among Adults With Heart Diseases: An Analysis by Race and Gender

Objective: This analysis describes variations in the estimated effect of depression on healthcare cost by race and gender of adults (aged 20+) hospitalized for diseases of the heart (DOH) in Tennessee.

Methods: We examined 2002 Tennessee Hospital Discharge Data reimbursement files (HDDS) of 402,511 adults hospitalized for DOH and depression. This sample had 36.6% patients with DOH (n=147,326) including 53% females, 14% African Americans (AA), and 9.2% with depression. Average race-gender specific costs were calculated and compared for three groups: DOH-Only (n=98,711), DOH+Depression (n=13,547), and DOH+Other mental diagnoses (n=35,068).

Results: The average healthcare cost per patient among 147,326 DOH inpatients was $36,497, but varied with comorbid mental health diagnoses. The average cost was significantly lower (p<.000) for DOH-Only group ($34,533) compared to DOH+Other mental disorders ($38,010) or those with DOH+Depression ($46,890). Cleary depression alone increased additional treatment cost by 35.6% compared to patients with DOH-Only. Attributable depression cost also affected race-gender comparisons. AAs with DOH+Depression had significantly (p<.000) both higher cost for same diagnoses ($59,430 vs. $45,837) length of stay relative to whites (4.36 vs. 2.89). AA men had higher cost relative to white men ($66,998 vs. 44,234), and so did AA women compared to white women ($56,033 vs. $44,067).

Conclusion: Healthcare cost is significantly higher among DOH patients with comorbid depression. Epidemiologic studies are needed to confirm or refute the hypothesis that healthcare costs among AA are increased because use of healthcare is delayed until problems are severe, thereby leading to longer hospital stay and more complicated treatment.