title: Contributions of diabetic macro-vascular complications and hip fracture to depression onset in elderly patients with diabetes: an 8-year population-based follow-up study.
abstract: OBJECTIVE
  To prospectively examine the roles of diabetic macro-vascular complications and hip fracture in association with depression onset in Taiwan's elderly diabetic population.
  
  
  METHODS
  A representative sample of elderly diabetic patients (n=144,216) identified in 2000 were linked to National Health Insurance claims (2000-2007) to ascertain the diagnoses of depression in both outpatient and inpatient settings. The person-year approach with Poisson assumption was used to estimate the hazard rates. Using Cox proportional hazard regression model, we evaluated the relative risk of depression in relation to diabetic macro-vascular complications and hip fracture. The additive effects from the above medical conditions were also assessed.
  
  
  RESULTS
  The 8-year cumulative risk of depression was 5.08%, representing an incidence density of 8.40 per 1000 patient-years. Hazard ratio (HR) with 95% confidence interval (CI) for the elderly diabetes associated with cardiovascular disease (CVD), hip fracture, and lower extremity amputation was 1.13 (1.04-1.23), 1.10 (0.91-1.34), and 1.25 (0.95-1.65), respectively. Additionally, we found that the more the complications or hip fracture, the higher the risk of depression onset in elderly diabetes.
  
  
  CONCLUSIONS
  The increased number of diabetic macro-vascular complications and hip fracture is significantly associated with a higher risk of depression onset in elderly diabetes. Future studies should be conducted to assess the feasibility and cost-effectiveness of intensive depression screening program in elderly diabetes suffering from macro-vascular complications and hip fracture.
authors: Department of Nursing, Tri-Service General Hospital, Shipai Road, Taipei, Taiwan.
authors: Hsueh-Hsing
authors: HH
authors: Pan
authors: Chung-Yi
authors: CY
authors: Li
authors: Pei-Chun
authors: PC
authors: Chen
authors: Ming-Der
authors: MD
authors: Lee
authors: Chun-Yu
authors: CY
authors: Liang
authors: Wen-Hsuan
authors: WH
authors: Hou
authors: Kwua-Yun
authors: KY
authors: Wang
mesh_terms: D000367:Age Factors; D000368:Aged; D002318:Cardiovascular Diseases / Q000150:complications / Q000523:psychology; D003866:Depressive Disorder / Q000209:etiology*; D003925:Diabetic Angiopathies / Q000150:complications* / Q000523:psychology; D005260:Female; D005500:Follow-Up Studies; D006620:Hip Fractures / Q000150:complications* / Q000523:psychology; D006801:Humans; D008297:Male; D016012:Poisson Distribution; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012306:Risk; D012737:Sex Factors; D013624:Taiwan