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Rheumatoid Arthritis Associated With Increased Risk for Depression – Rheumatology Advisor

February 26th, 2020 8:43 pm

Resultsfrom 2 longitudinal cohort studies conducted in South Korea indicate asignificantly increased risk for depression among patients with rheumatoidarthritis (RA), with women and those >30 years of age displaying the highestrates. This is according to an article published in Rheumatology.

Investigatorsabstracted data from the Korean Health Insurance Review and Assessment Service National Sample Cohort (HIRA-NSC) from the years 2002-2013. The HIRA-NSC is apopulation-based cohort established by the National Health Insurance Service ofSouth Korea. HIRA-NSC queries demographics, health, and diagnostic data from >1million individuals randomly selected from South Koreas National HealthInsurance Database.

The present analyses included data from 114,369,638 medical claims filed by 1,125,691 patients. Patients with depression and/or RA were identified through their respective International Statistical Classification of Diseases version 10 (ICD-10) codes. Two studies were designed. Study I matched patients with depression 1:4 with cohort members without depression. Study matched patients with RA 1:4 with cohort members without RA. Matching in both studies was performed for age group, sex, income bracket, and region of residence. Cox proportional hazards models were used to calculate hazard ratios (HRs) for depression and RA in each study. HR calculations were adjusted for number of comorbidities.

StudyI enrolled a total of 38,087 patients with depression and 152,348 individualsin a control group. A greater proportion of the patients with depression(n=1260; 0.7%) had a diagnosis of RA compared with the control group (n=883;0.6%) (P =.02). However, the HR for RA was not significantly elevated inthe depression group compared with the control group.

StudyII enrolled a total of 7385 patients with RA and 29,540 individuals in acontrol group, of whom 408 (5.5%) and 1246 (4.3%) had a diagnosis of depression,respectively (P <.001). Patients with RA had significantly increasedrisk for depression compared to those in the control group without RA (HR,1.20; 95% CI, 1.07-1.34; P =.002). In subgroup analyses, patients withRA over 30 years of age had the greatest HRs for depression compared with theircontrol subgroups.

Specifically,patients with RA aged 30-59 years (HR, 1.17; 95% CI, 1.01-1.36; P =.036)and patients 60 years (HR, 1.29; 95% CI, 1.08-1.55; P =.006) hadsignificantly elevated risk for depression compared to controls in the same agebrackets. Women with RA, unlike men, also displayed significantly higherdepression risk compared with controls of the same gender (HR, 1.19; 95%,1.05-1.35; P =.006).

Theseresults suggest that while RA increases the risk for depression, this associationis not bidirectional. Women with RA and patients >30 years were particularlysusceptible to depression. Of note, data on RA and depression severity were notavailable, nor were data on smoking, alcohol consumption, or physical activity.As such, analyses may not have accounted for all possible factors contributing todepression. Even so, the elevated HRs for depression observed among RAsubgroups emphasize the need for mental health care access for patients withRA.

Reference

Kim SY, Chanyang M, Oh DJ, Choi HG. Association between depression and rheumatoid arthritis: two longitudinal follow-up studies using a national sample cohort [published online November 19, 2019]. Rheumatology (Oxford). doi:10.1093/rheumatology/kez559

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Rheumatoid Arthritis Associated With Increased Risk for Depression - Rheumatology Advisor

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