Session Information
Session Type: ACR Poster Session B
Session Time: 9:00AM-11:00AM
Background/Purpose: Comorbidities
represent a major challenge for patients with rheumatoid arthritis. Depression
is one of the most common comorbidities with prevalence up to 38%. Disease
activity measures and comorbidities show inconsistent association with
depression. There is limited data assessing the prevalence of depression and
its association with clinical characteristics in a large cohort, among
different countries.
Objectives: Our study aimed
to assess the prevalence of depression diagnosis and patient-reported anxiety
or depression and their association with 28-disease activity score (DAS28) and
comorbidity among 17 different countries, using the COMORA dataset¹ (‘Prevalence
of Comorbidities in Rheumatoid Arthritis and evaluation of their monitoring:
results of an international, cross-sectional study’).
Methods: Demographics,
clinical characteristics, treatment and comorbidities were recorded for each
patient. Multilevel binary logistic regression models were constructed for depression
diagnosis (DD) and for patient-reported anxiety or depression (PRAD). An
initial null model tested for inter-country differences in prevalence.
Unadjusted models were then built for each independent variable (DAS28 and
comorbidity). Models were then adjusted for age and sex.
Results: 3674 patients
from 17 countries were included [mean (SD) age 56 (13) years; DAS28 3.72 (1.5)].
30% were diagnosed with at least one comorbidity, 15% with a depression
diagnosis and 38% reported anxiety or depression. Moving from a lower to a
higher risk country increased the odds of DD and PRAD by a median of 2.5 and 1.76
fold respectively. In unadjusted models, DAS28 and comorbidity count were positively
associated with the measures of depression. Adjusting for age and sex, the
association between DAS28 and odds of DD showed borderline-significant
variation between countries (p=0.053); in the ‘average’ country there was no
association, but the higher a country’s mean DAS28, the greater the increase in
the odds of DD for each unit of DAS28. The number of comorbidities was
positively associated with the odds of DD and the association did not vary
between countries. DAS28 and comorbidity count were positively associated with
the odds of PRAD and neither of these associations differed significantly by
country.
Conclusion: This study
confirms that RA patients have a high prevalence of depression and that this varies
between countries. Comorbidity is associated with prevalence of depression whilst
the association with DAS28 is more variable. These data suggest that country
level factors and additional comorbidity play particularly important roles for
depression.
References: 1 Dougados M, Ann
Rheum Dis, 2014.
Table 1: Logistic regression models of depression diagnosis and
patient-reported anxiety or depression.
|
Outcome |
Depression diagnosis |
Anxiety or depression |
|
|
|
|
|
Null model: |
|
|
|
Intercept (95% CI) |
-1.89 (-2.32, -1.46) |
-0.59 (-0.86, -0.32) |
|
Intercept variance (95% CI) |
0.74 (0.34, 1.59) |
0.29 (0.14, 0.61) |
|
Intercept LR test: Chi-sq, p |
205.0, p<0.001 |
204.8, p<0.001 |
|
Median odds ratio (95% CrI) |
2.47 (1.82, 3.74) |
1.76 (1.46, 2.28) |
|
|
|
|
|
Unadjusted models: |
|
|
|
DAS28-ESR (95% CI), p |
0.11 (0.04, 0.17), p=0.002 |
0.40 (0.35, 0.45), p<0.001 |
|
Comorbidity (95% CI), p |
0.25 (0.12, 0.38), p<0.001 |
0.24 (0.14, 0.35), p<0.001 |
|
|
|
|
|
Adjusted model: |
|
|
|
Age (95% CI), p |
-0.01 (-0.09, 0.07), p=0.806 |
0.02 (-0.04, 0.08), p=0.486 |
|
Female (95% CI), p |
0.69 (0.40, 0.98), p<0.001 |
0.53 (0.33, 0.73), p<0.001 |
|
Comorbidity (95% CI), p |
0.26 (0.12, 0.40), p<0.001 |
0.21 (0.10, 0.33), p<0.001 |
|
DAS28-ESR (95% CI), p |
0.04 (-0.06, 0.14), p=0.409 |
0.38 (0.33, 0.44), p<0.001 |
|
Comorbidity LR test: Chi-sq, p |
1.53, p=0.464 |
0.23, p=0.891 |
|
DAS28-ESR LR test: Chi-sq, p |
5.88, p=0.053 |
5.27, p=0.072 |
|
DAS28-ESR slope variance (95% CI) |
0.01 (0.00, 0.07) |
n/a |
|
DAS28-ESR I-S covariance (95% CI) |
0.08 (-0.02, 0.18) |
n/a |
|
DAS28-ESR I-S correlation |
0.78 |
n/a |
|
Values presented are logits (log-odds) unless otherwise stated. Chi-sq Chi-square; CI Confidence Interval; CrI Credible Interval; I-S Intercept-Slope; LR likelihood ratio |
||
To cite this abstract in AMA style:
Dumitru R, Hensor EMA, Hmamouchi I, Emery P, Dougados M, Buch MH. Geography and the Influence of Comorbidity on the Prevalence of Depression in Patients with Rheumatoid Arthritis,a Study Across Seventeen Countries [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). https://acrabstracts.org/abstract/geography-and-the-influence-of-comorbidity-on-the-prevalence-of-depression-in-patients-with-rheumatoid-arthritisa-study-across-seventeen-countries/. Accessed .« Back to 2015 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/geography-and-the-influence-of-comorbidity-on-the-prevalence-of-depression-in-patients-with-rheumatoid-arthritisa-study-across-seventeen-countries/