Antidepressant use, depression, and new-onset diabetes among elderly Medicare beneficiaries (在老年医疗保险受益者中调查抗抑郁药的使用、抑郁症以及新发糖尿病)

Background The aim of the present study was to examine the association between antidepressant use, diagnosed depression, and new-onset diabetes among elderly Medicare beneficiaries. Methods Longitudinal data from merged survey and claims from the nationally representative Medicare Current Beneficiary Survey( MCBS) from 1999 to 2005 were used. Diabetes incidence was extracted from claims and survey data over a 3-year period. Data regarding depression and antidepressant use over time were obtained. Multivariate logistic regression analysis was used to examine associations between antidepressant use, depression, and new-onset diabetes, adjusted for demographic, socioeconomic, and lifestyle risk factors. Analyses accounted for the complex design of the MCBS. Results The incident diabetes rate was 4.8% for those 'without depression and without antidepressants' and 9.5% for those with any antidepressant use in all 3 years and diagnosed depression'. Compared with Medicare beneficiaries who did not report any antidepressant use, beneficiaries reporting antidepressant use in all 3 years were 50% more likely to have new-onset diabetes. However, when diagnosed depression was entered in the model, there was no significant association between long-term antidepressant use and new-onset diabetes. Medicare beneficiaries with any depression were twice as likely as those without depression to develop diabetes (adjusted odds ratio 2.04; 95% confidence interval 1.51, 2.75). Conclusions Depression independently increased the risk of developing diabetes in the MCBS population, although there is no evidence of an association between antidepressant use and new-onset diabetes. If replicated, these results have significant clinical implications. [ABSTRACT FROM AUTHOR]

摘要 背景 本研究的目的是在老年医疗保险受益者中调查抗抑郁药的使用、抑郁症的诊断与新发糖尿病之间的关系。 方法 纵向数据来自于合并的调查与索赔数据，即1999至2005年间全国典型的医疗保险当前受益人调查（Medicare Current Beneficiary Survey MCBS）数据。糖尿病发生率来自于超过3年的索赔与调查数据。并获取有关抑郁症以及随着时间的推移抗抑郁药使用情况的数据。使用多因素Logistic回归分析来检验抗抑郁药的使用情况以及抑郁症与新发糖尿病之间的关系，并且经过了人口统计学、社会经济学以及生活方式等危险因素的校正。分析解释了MCBS的复杂设计。 结果 那些'没有抑郁症也没有使用抗抑郁药物'的老年人糖尿病发生率为4.8%，那些'使用任何抗抑郁药物总共达到3年以及已经诊断抑郁症'的老年人糖尿病发生率为9.5%。与那些没有报告使用任何抗抑郁药的医疗保险受益者相比较，报告使用任何抗抑郁药物总共达到3年的受益者出现新发糖尿病的可能性高50%。然而，若将已经诊断的抑郁症也并入模型中，则长期使用抗抑郁药与新发糖尿病之间就没有显著的相关性了。合并任何程度抑郁症的医疗保险受益者发生糖尿病的可能性是那些未合并抑郁症受益者的2倍（校正后优势比为2.04；95%CI为1.51，2.75）。 结论 在MCBS人群中，抑郁症可独立增加患糖尿病的风险，虽然目前还没有证据表明抗抑郁药的使用与新发糖尿病之间具有相关性。如果能够得到重复研究的证实，那么这些结果将具有重要的临床意义。 [ABSTRACT FROM AUTHOR]