title: Depression Is Associated with Readmission for Acute Exacerbation of Chronic Obstructive Pulmonary Disease.
abstract: BACKGROUND
  Hospitalization for acute exacerbation of chronic obstructive pulmonary disease (COPD) is associated with significant morbidity and health care costs, and hospitals in the United States are now penalized by the Centers for Medicare and Medicaid Services for excessive readmissions. Identifying patients at risk of readmission is important, but modifiable risk factors have not been clearly established, and the potential contributing role of psychological disease has not been examined adequately. We hypothesized that depression and anxiety would increase the risk of both short- and long-term readmissions for acute exacerbation of COPD.
  
  
  OBJECTIVE
  To characterize the associations between depression and anxiety and COPD readmission risk.
  
  
  METHODS
  We examined the medical records for all patients with a primary diagnosis of acute exacerbation of COPD by International Classification of Diseases, Ninth Revision codes admitted to the University of Alabama at Birmingham Hospital between November 2010 and October 2012. Those who did not meet the standardized study criteria for acute exacerbation of COPD and those with other respiratory illnesses as the primary diagnosis were excluded. Comorbidities were recorded on the basis of physician documentation of the diagnosis and/or the use of medications in the electronic medical record. Multivariable regression analyses identified factors associated with readmission for acute exacerbation of COPD at 1 year and within 30 and 90 days.
  
  
  RESULTS
  Four hundred twenty-two patients were included, with 132 readmitted in 1 year. Mean age was 64.8 ± 11.7 years, and mean percent predicted FEV1 was 48.1 ± 18.7%. On univariate analysis, readmitted patients had lower percent predicted FEV1 (44.9 ± 17.3% vs. 50.2 ± 19.4%; P = 0.05) and a higher frequency of depression (47.7% vs. 23.4%; P < 0.001). On multivariable analysis, 1-year readmission was independently associated with depression (adjusted odds ratio [OR], 2.67; 95% confidence interval [CI], 1.59-4.47) and in-hospital tobacco cessation counseling (adjusted OR, 0.34; 95% CI, 0.18-0.66). Depression also predicted readmission at 30 days (adjusted OR, 3.83; 95% CI, 1.84-7.96) and 90 days (adjusted OR, 2.47; 95% CI, 1.34-4.55).
  
  
  CONCLUSIONS
  Depression is an independent risk factor for both short- and long-term readmissions for acute exacerbation of COPD and may represent a modifiable risk factor. In-hospital tobacco cessation counseling was also associated with reduced 1-year readmission.
authors.affiliation: 1 Division of Pulmonary, Allergy, and Critical Care, Department of Medicine and University of Alabama at Birmingham Lung Health Center, University of Alabama at Birmingham, Birmingham, Alabama; and.
authors.forename: Anand S
authors.initials: AS
authors.lastname: Iyer
authors.affiliation: 1 Division of Pulmonary, Allergy, and Critical Care, Department of Medicine and University of Alabama at Birmingham Lung Health Center, University of Alabama at Birmingham, Birmingham, Alabama; and.
authors.forename: Surya P
authors.initials: SP
authors.lastname: Bhatt
authors.affiliation: 1 Division of Pulmonary, Allergy, and Critical Care, Department of Medicine and University of Alabama at Birmingham Lung Health Center, University of Alabama at Birmingham, Birmingham, Alabama; and.
authors.forename: Jeffrey J
authors.initials: JJ
authors.lastname: Garner
authors.affiliation: 1 Division of Pulmonary, Allergy, and Critical Care, Department of Medicine and University of Alabama at Birmingham Lung Health Center, University of Alabama at Birmingham, Birmingham, Alabama; and.|2 Veterans Affairs Medical Center, Birmingham, Alabama.
authors.forename: J Michael
authors.initials: JM
authors.lastname: Wells
authors.affiliation: 1 Division of Pulmonary, Allergy, and Critical Care, Department of Medicine and University of Alabama at Birmingham Lung Health Center, University of Alabama at Birmingham, Birmingham, Alabama; and.|2 Veterans Affairs Medical Center, Birmingham, Alabama.
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Trevor
authors.affiliation: 1 Division of Pulmonary, Allergy, and Critical Care, Department of Medicine and University of Alabama at Birmingham Lung Health Center, University of Alabama at Birmingham, Birmingham, Alabama; and.
authors.forename: Neha M
authors.initials: NM
authors.lastname: Patel
authors.affiliation: 1 Division of Pulmonary, Allergy, and Critical Care, Department of Medicine and University of Alabama at Birmingham Lung Health Center, University of Alabama at Birmingham, Birmingham, Alabama; and.
authors.forename: deNay
authors.initials: d
authors.lastname: Kirkpatrick
authors.affiliation: 1 Division of Pulmonary, Allergy, and Critical Care, Department of Medicine and University of Alabama at Birmingham Lung Health Center, University of Alabama at Birmingham, Birmingham, Alabama; and.
authors.forename: John C
authors.initials: JC
authors.lastname: Williams
authors.affiliation: 1 Division of Pulmonary, Allergy, and Critical Care, Department of Medicine and University of Alabama at Birmingham Lung Health Center, University of Alabama at Birmingham, Birmingham, Alabama; and.|2 Veterans Affairs Medical Center, Birmingham, Alabama.
authors.forename: Mark T
authors.initials: MT
authors.lastname: Dransfield
mesh_terms: D000368:Aged; D015331:Cohort Studies; D015897:Comorbidity; D003376:Counseling / Q000706:statistics & numerical data; D003863:Depression / Q000453:epidemiology*; D003866:Depressive Disorder / Q000453:epidemiology*; D018450:Disease Progression; D005260:Female; D006760:Hospitalization; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010359:Patient Readmission / Q000706:statistics & numerical data*; D029424:Pulmonary Disease, Chronic Obstructive / Q000453:epidemiology* / Q000523:psychology / Q000628:therapy; D012189:Retrospective Studies; D012307:Risk Factors; D012907:Smoking / Q000453:epidemiology / Q000628:therapy; D016540:Smoking Cessation / Q000706:statistics & numerical data; D014481:United States / Q000453:epidemiology
keywords: chronic obstructive pulmonary disease; depression; exacerbations; risk