Association of Depression Risk with Patient Experience, Healthcare Expenditure, and Health Resource Utilization Among Adults with Atherosclerotic Cardiovascular Disease

  • Victor OkunrintemiEmail author
  • Javier Valero-Elizondo
  • Erin D. Michos
  • Joseph A. Salami
  • Oluseye Ogunmoroti
  • Chukwuemeka Osondu
  • Martin Tibuakuu
  • Eve-Marie Benson
  • Timothy M. Pawlik
  • Michael J. Blaha
  • Khurram Nasir
Original Research



Approximately 20% of patients with atherosclerotic cardiovascular disease (ASCVD) suffer from depression.


To compare healthcare expenditures and utilization, healthcare-related quality of life, and patient-centered outcomes among ASCVD patients, based on their risk for depression (among those without depression), and those with depression (vs. risk-stratified non-depressed).

Design and Setting

The 2004–2015 Medical Expenditure Panel Survey (MEPS) was used for this study.


Adults ≥ 18 years with a diagnosis of ASCVD, ascertained by ICD-9 codes and/or self-reported data. Individuals with a diagnosis of depression were identified by ICD-9 code 311. Participants were stratified by depression risk, based on the Patient Health Questionnaire-2.


A total of 19,840 participants were included, translating into 18.3 million US adults, of which 8.6% (≈ 1.3 million US adults) had a high risk for depression and 18% had a clinical diagnosis of depression. Among ASCVD patients without depression, those with a high risk (compared with low risk) had increased overall and out-of-pocket expenditures (marginal differences of $2880 and $287, respectively, both p < 0.001), higher odds for resource utilization, and worse patient experience and healthcare quality of life (HQoL). Furthermore, compared with individuals who had depression, participants at high risk also reported worse HQoL and had higher odds of poor perception of their health status (OR 1.83, 95% CI [1.50, 2.23]) and poor patient-provider communication (OR 1.29 [1.18, 1.42]).


The sample population includes self-reported diagnosis of ASCVD; therefore, the risk of underestimation of the cohort size cannot be ruled out.


Almost 1 in 10 individuals with ASCVD without diagnosis of depression is at high risk for it and has worse health outcomes compared with those who already have a diagnosis of depression. Early recognition and treatment of depression may increase healthcare efficiency, positive patient experience, and HQoL among this vulnerable population.


atherosclerotic cardiovascular disease depression healthcare economics healthcare-related quality of life patient experience 


Compliance with Ethical Standards

Conflict of Interest

The authors declare that they do not have a conflict of interest.

Supplementary material

11606_2019_5325_MOESM1_ESM.docx (59 kb)
ESM 1 (DOCX 58 kb)


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Copyright information

© Society of General Internal Medicine 2019

Authors and Affiliations

  • Victor Okunrintemi
    • 1
    Email author
  • Javier Valero-Elizondo
    • 2
  • Erin D. Michos
    • 3
    • 4
  • Joseph A. Salami
    • 5
  • Oluseye Ogunmoroti
    • 3
  • Chukwuemeka Osondu
    • 5
  • Martin Tibuakuu
    • 6
  • Eve-Marie Benson
    • 4
  • Timothy M. Pawlik
    • 7
  • Michael J. Blaha
    • 3
  • Khurram Nasir
    • 8
  1. 1.Department of Internal MedicineEast Carolina UniversityGreenvilleUSA
  2. 2.Center for Outcomes Research and EvaluationYale New Haven HospitalNew HavenUSA
  3. 3.Division of CardiologyJohns Hopkins School of MedicineBaltimoreUSA
  4. 4.Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreUSA
  5. 5.Baptist Health South FloridaMiamiUSA
  6. 6.Department of MedicineSt. Luke’s HospitalChesterfieldUSA
  7. 7.Department of SurgeryWexner Medical CenterColumbusUSA
  8. 8.Section of Cardiovascular MedicineYale UniversityNew HavenUSA

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