Associations between untreated depression and secondary health care utilization in patients with hypertension and/or diabetes

Abstract

Purpose

We determined the prevalence of untreated depression in patients with hypertension (HT) and/or diabetes (DM) and estimated the extra health care use and expenditures associated with this comorbidity in a rural Hungarian adult population. We also assessed the potential workload of systematic screening for depression in this patient group.

Methods

General health check database from a primary care programme containing survey data of 2027 patients with HT and/or DM was linked to the outpatient secondary care use database of National Institute of Health Insurance Fund Management. Depression was ascertained by Beck Depression Inventory score and antidepressant drug use. The association between untreated depression and secondary healthcare utilization indicated by number of visits and expenses was evaluated by multiple logistic regression analysis controlled for socioeconomic/lifestyle factors and comorbidity. The age-, sex- and education-specific observations were used to estimate the screening workload for an average general medical practice.

Results

The frequency of untreated depression was 27.08%. The untreated severe depression (7.45%) was associated with increased number of visits (OR 1.60, 95% CI 1.11–2.31) and related expenses (OR 2.20, 95% CI 1.50–3.22) in a socioeconomic status-independent manner. To identify untreated depression cases among patients with HT and/or DM, an average GP has to screen 42 subjects a month.

Conclusion

It seems to be reasonable and feasible to screen for depression in patients with HT and/or DM in the primary care, in order to detect cases without treatment (which may be associated with increase of secondary care visits and expenditures) and to initiate the adequate treatment of them.

Appendices

Appendix 1

Association between any indicator of depression among patients with hypertension and/or diabetes and a higher-than-median episode number per year in outpatient institutions according to the multivariate logistic regression analysis (significant results are in bold)

	Risk for above-median episode numbersa
	Complete case analysis (N = 1772)	Multiple imputation (N = 2027)
Gender
Female	1.05 [0.84–1.32]	1.03 [0.83–1.27]
Male	1 (reference)	1 (reference)
Age
Year	1.01 [1.00–1.02]	1.01 [1.00–1.02]
Education
Primary	1.05 [0.74–1.50]	1.26 [0.91–1.74]
Vocational	1.28 [0.87–1.90]	1.39 [0.97–1.99]
High school	1.17 [0.80–1.73]	1.38 [0.96–1.97]
Tertiary	1.21 [0.74–1.95]	1.33 [0.84–2.10]
Less than primary	1 (reference)	1 (reference)
Ethnicity
Roma	1.07 [0.69–1.67]	1.11 [0.74–1.68]
Non-Roma	1 (reference)	1 (reference)
Alcohol consumption by AUDIT
Problem drinker	0.66 [0.24–1.84]	0.71 [0.29–1.75]
Non-problem drinker	1 (reference)	1 (reference)
Smoking
Occasional	1.61 [0.84–3.08]	1.86 [1.01–3.42]
Regular	0.92 [0.69–1.22]	0.89 [0.67–1.17]
Former	1.40 [1.07–1.81]	1.35 [1.03–1.77]
Never	1 (reference)	1 (reference)
BMI
Obese	1.07 [0.87–1.32]	1.10 [0.90–1.34]
Normal	1 (reference)	1 (reference)
Central obesity
Central obesity	1.24 [0.82–1.86]	1.14 [0.77–1.68]
Normal	1 (reference)	1 (reference)
Accompanying disease
Chronic musculoskeletal disorders	1.54 [1.23–1.93]	1.58 [1.27–1.95]
Visual acuity impairment or hearing loss	1.28 [0.94–1.73]	1.24 [0.92–1.66]
Osteoporosis	1.30 [0.89–1.89]	1.27 [0.88–1.83]
Chronic kidney disorder	1.01 [0.68–1.50]	1.04 [0.71–1.52]
No accompanying disorder	1 (reference)	1 (reference)
Compliance
Purchased medicineb less than four times a year	0.98 [0.76–1.26]	1.00 [0.79–1.27]
Purchased medicineb at least four times a year	1 (reference)	1 (reference)
Generel practitioner (GP)
GP 1	0.80 [0.53–1.21]	0.82 [0.55–1.23]
GP 2	0.52 [0.33–0.82]	0.55 [0.35–0.85]
GP 3	0.79 [0.42–1.50]	0.93 [0.53–1.61]
GP 4	0.93 [0.41–2.12]	0.93 [0.51–1.71]
GP 5	0.84 [0.54–1.29]	0.88 [0.58–1.33]
GP 6	1.57 [0.83–2.97]	1.59 [0.99–2.55]
GP 7	0.76 [0.50–1.16]	0.81 [0.53–1.22]
GP 8	0.91 [0.49–1.67]	1.14 [0.67–1.92]
GP 9	0.58 [0.23–1.48]	1.02 [0.51–2.05]
GP 10	0.26 [0.15–0.45]	0.27 [0.16–0.46]
GP 11	0.31 [0.18–0.52]	0.32 [0.19–0.54]
GP 12	0.49 [0.29–0.84]	0.53 [0.31–0.89]
GP 13	0.34 [0.20–0.58]	0.36 [0.22–0.60]
GP 14	0.37 [0.23–0.61]	0.40 [0.25–0.66]
GP 15	1 (reference)	1 (reference)
Depression
Depression (BDI > 9 and did not purchase antidepressant in 12 months)	1.21 [0.96–1.53]	1.25 [1.00–1.56]
Purchased antidepressant in 12 months	3.42 [2.29–5.12]	3.24 [2.21–4.75]
No depression (BDI ≤ 9 and did not purchase antidepressant in 12 months)	1 (reference)	1 (reference)

1. ^aOdds ratio [95% confidence interval]
2. ^bAntihypertensive and/or antidiabetic medicine

Appendix 2

Association between any indicator of depression among patients with hypertension and/or diabetes and a higher-than-median reimbursement per year in outpatient institutions according to the multivariate logistic regression analysis (significant results are in bold)

	Risk for above-median expensesa
	Complete case analysis (N = 1772)	Multiple imputation (N = 2027)
Gender
Female	1.22 [0.97–1.53]	1.10 [0.89–1.36]
Male	1 (reference)	1 (reference)
Age
Year	1.01 [1.00–1.02]	1.01 [1.00–1.02]
Education
Primary	1.11 [0.78–1.59]	1.25 [0.90–1.73]
Vocational	1.35 [0.91–2.00]	1.34 [0.93–1.93]
High school	1.18 [0.80–1.74]	1.27 [0.88–1.82]
Tertiary	1.31 [0.81–2.13]	1.27 [0.80–2.02]
Less than primary	1 (reference)	1 (reference)
Ethnicity
Roma	0.92 [0.59–1.44]	1.00 [0.66–1.52]
Non-Roma	1 (reference)	1 (reference)
Alcohol consumption by AUDIT
Problem drinker	0.60 [0.21–1.69]	0.63 [0.25–1.57]
Non-problem drinker	1 (reference)	1 (reference)
Smoking
Occasional	1.33 [0.69–2.56]	1.64 [0.86–3.14]
Regular	0.95 [0.72–1.26]	0.94 [0.72–1.23]
Former	1.44 [1.11–1.88]	1.41 [1.08–1.86]
Never	1 (reference)	1 (reference)
BMI
Obese	1.03 [0.83–1.27]	1.07 [0.87–1.30]
Normal	1 (reference)	1 (reference)
Central obesity
Central obesity	1.07 [0.72–1.61]	1.05 [0.71–1.54]
Normal	1 (reference)	1 (reference)
Accompanying disease
Chronic musculoskeletal disorders	1.52 [1.21–1.91]	1.56 [1.26–1.94]
Visual acuity impairment or hearing loss	1.39 [1.02–1.90]	1.30 [0.96–1.75]
Osteoporosis	1.56 [1.06–2.29]	1.50 [1.03–2.18]
Chronic kidney disorder	1.05 [0.70–1.56]	1.06 [0.72–1.56]
No accompanying disorder	1 (reference)	1 (reference)
Compliance
Purchased medicineb less than four times a year	0.98 [0.76–1.26]	1.00 [0.79–1.26]
Purchased medicineb at least four times a year	1 (reference)	1 (reference)
Generel practitioner (GP)
GP 1	0.86 [0.57–1.31]	0.87 [0.58–1.31]
GP 2	0.58 [0.37–0.90]	0.57 [0.36–0.88]
GP 3	1.11 [0.58–2.10]	1.22 [0.70–2.13]
GP 4	1.21 [0.52–2.83]	1.08 [0.58–1.99]
GP 5	0.90 [0.58–1.39]	0.92 [0.61–1.41]
GP 6	2.07 [1.07–4.03]	2.00 [1.23–3.25]
GP 7	1.06 [0.69–1.63]	1.10 [0.73–1.67]
GP 8	0.99 [0.54–1.84]	1.11 [0.65–1.88]
GP 9	1.09 [0.43–2.78]	1.69 [0.81–3.50]
GP 10	0.22 [0.12–0.38]	0.23 [0.13–0.39]
GP 11	0.33 [0.20–0.56]	0.35 [0.21–0.58]
GP 12	0.56 [0.33–0.97]	0.58 [0.34–0.99]
GP 13	0.28 [0.17–0.48]	0.30 [0.18–0.50]
GP 14	0.35 [0.21–0.58]	0.39 [0.24–0.63]
GP 15	1 (reference)	1 (reference)
Depression
Depression (BDI > 9 and did not purchase antidepressant in 12 months)	1.44 [1.14–1.81]	1.52 [1.21–1.90]
Purchased antidepressant in 12 months	4.41 [2.87–6.79]	4.17 [2.78–6.25]
No depression (BDI ≤ 9 and did not purchase antidepressant in 12 months)	1 (reference)	1 (reference)

1. ^aOdds ratio [95% confidence interval]
2. ^bAntihypertensive and/or antidiabetic medicine

Appendix 3

Association between different categories of depression among patients with hypertension and/or diabetes and a higher-than-median episode number per year in outpatient institutions according to the multivariate logistic regression analysis (significant results are in bold)

	Risk for above-median episode numbersa
	Complete case analysis (N = 1772)	Multiple imputation (N = 2027)
Gender
Female	1.05 [0.83–1.31]	1.03 [0.83–1.27]
Male	1 (reference)	1 (reference)
Age
Year	1.01 [1.00–1.02]	1.01 [1.00–1.02]
Education
Primary	1.08 [0.76–1.55]	1.30 [0.94–1.80]
Vocational	1.36 [0.91–2.02]	1.46 [1.01–2.10]
High school	1.25 [0.84–1.85]	1.45 [1.01–2.09]
Tertiary	1.30 [0.80–2.11]	1.41 [0.89–2.24]
Less than primary	1 (reference)	1 (reference)
Ethnicity
Roma	1.00 [0.64–1.57]	1.05 [0.69–1.59]
Non-Roma	1 (reference)	1 (reference)
Alcohol consumption by AUDIT
Problem drinker	0.61 [0.22–1.72]	0.66 [0.26–1.65]
Non-problem drinker	1 (reference)	1 (reference)
Smoking
Occasional	1.56 [0.81–3.00]	1.84 [0.99–3.39]
Regular	0.90 [0.68–1.20]	0.88 [0.66–1.16]
Former	1.38 [1.06–1.80]	1.35 [1.03–1.77]
Never	1 (reference)	1 (reference)
BMI
Obese	1.06 [0.86–1.31]	1.08 [0.89–1.32]
Normal	1 (reference)	1 (reference)
Central obesity
Central obesity	1.23 [0.82–1.85]	1.12 [0.76–1.65]
Normal	1 (reference)	1 (reference)
Accompanying disease
Chronic musculoskeletal disorders	1.55 [1.23–1.94]	1.58 [1.28–1.96]
Visual acuity impairment or hearing loss	1.26 [0.92–1.71]	1.22 [0.91–1.64]
Osteoporosis	1.30 [0.89–1.90]	1.28 [0.89–1.86]
Chronic kidney disorder	1.00 [0.67–1.48]	1.02 [0.70–1.50]
No accompanying disorder	1 (reference)	1 (reference)
Compliance
Purchased medicineb less than four times a year	0.99 [0.77–1.27]	1.02 [0.81–1.29]
Purchased medicineb at least four times a year	1 (reference)	1 (reference)
Generel practitioner (GP)
GP 1	0.80 [0.53–1.22]	0.82 [0.55–1.23]
GP 2	0.54 [0.34–0.84]	0.56 [0.36–0.87]
GP 3	0.80 [0.42–1.51]	0.92 [0.53–1.60]
GP 4	0.88 [0.38–2.04]	0.88 [0.48–1.64]
GP 5	0.84 [0.54–1.29]	0.87 [0.57–1.32]
GP 6	1.53 [0.81–2.91]	1.56 [0.97–2.50]
GP 7	0.76 [0.50–1.17]	0.80 [0.53–1.21]
GP 8	0.90 [0.49–1.66]	1.14 [0.67–1.92]
GP 9	0.57 [0.22–1.46]	1.02 [0.51–2.05]
GP 10	0.26 [0.15–0.44]	0.26 [0.15–0.45]
GP 11	0.31 [0.19–0.53]	0.32 [0.19–0.54]
GP 12	0.50 [0.29–0.85]	0.52 [0.31–0.89]
GP 13	0.34 [0.20–0.58]	0.35 [0.21–0.59]
GP 14	0.36 [0.22–0.60]	0.39 [0.24–0.64]
GP 15	1 (reference)	1 (reference)
Depression
No depression by BDI, purchased antidepressant in 12 months	2.24 [1.24–4.03]	2.39 [1.36–4.19]
Mild depression by BDI, did not purchase antidepressant in 12 months	0.98 [0.73–1.33]	1.04 [0.79–1.38]
Mild depression by BDI, purchased antidepressant in 12 months	3.45 [1.44–8.28]	3.53 [1.45–8.58]
Moderate depression by BDI, did not purchase antidepressant in 12 months	1.42 [0.96–2.11]	1.41 [0.96–2.06]
Moderate depression by BDI, purchased antidepressant in 12 months	3.45 [1.31–9.11]	2.72 [1.14–6.50]
Severe depression by BDI, did not purchase antidepressant in 12 months	1.60 [1.07–2.38]	1.60 [1.11–2.31]
Severe depression by BDI, purchased antidepressant in 12 months	7.85 [3.14–19.58]	6.80 [2.85–16.21]
No depression by BDI, did not purchase antidepressant in 12 months	1 (reference)	1 (reference)

1. ^aOdds ratio [95% confidence interval]
2. ^bAntihypertensive and/or antidiabetic medicine

Appendix 4

Association between different categories of depression among patients with hypertension and/or diabetes and a higher-than-median reimbursement per year in outpatient institutions according to the multivariate logistic regression analysis (significant results are in bold)

	Risk for above-median expensesa
	Complete case analysis (N = 1772)	Multiple imputation (N = 2027)
Gender
Female	1.21 [0.96–1.52]	1.10 [0.88–1.36]
Male	1 (reference)	1 (reference)
Age
Year	1.01 [1.00–1.02]	1.01 [1.00–1.02]
Education
Primary	1.15 [0.80–1.64]	1.30 [0.93–1.81]
Vocational	1.44 [0.97–2.16]	1.44 [0.99–2.08]
High school	1.26 [0.85–1.87]	1.36 [0.94–1.97]
Tertiary	1.43 [0.87–2.33]	1.38 [0.87–2.19]
Less than primary	1 (reference)	1 (reference)
Ethnicity
Roma	0.87 [0.55–1.36]	0.95 [0.62–1.44]
Non-Roma	1 (reference)	1 (reference)
Alcohol consumption by AUDIT
Problem drinker	0.58 [0.20–1.65]	0.59 [0.23–1.50]
Non-problem drinker	1 (reference)	1 (reference)
Smoking
Occasional	1.25 [0.64–2.42]	1.59 [0.84–3.00]
Regular	0.93 [0.70–1.23]	0.92 [0.71–1.21]
Former	1.42 [1.09–1.85]	1.40 [1.06–1.83]
Never	1 (reference)	1 (reference)
BMI
Obese	1.02 [0.82–1.25]	1.05 [0.86–1.28]
Normal	1 (reference)	1 (reference)
Central obesity
Central obesity	1.07 [0.71–1.62]	1.04 [0.71–1.53]
Normal	1 (reference)	1 (reference)
Accompanying disease
Chronic musculoskeletal disorders	1.52 [1.20–1.91]	1.57 [1.26–1.95]
Visual acuity impairment or hearing loss	1.35 [0.99–1.85]	1.26 [0.94–1.70]
Osteoporosis	1.53 [1.04–2.25]	1.49 [1.02–2.17]
Chronic kidney disorder	1.03 [0.69–1.53]	1.04 [0.70–1.53]
No accompanying disorder	1 (reference)	1 (reference)
Compliance
Purchased medicineb less than four times a year	0.99 [0.76–1.27]	1.02 [0.80–1.29]
Purchased medicineb at least four times a year	1 (reference)	1 (reference)
Generel practitioner (GP)
GP 1	0.88 [0.58–1.34]	0.88 [0.58–1.32]
GP 2	0.60 [0.38–0.94]	0.59 [0.38–0.91]
GP 3	1.12 [0.59–2.13]	1.23 [0.70–2.15]
GP 4	1.21 [0.51–2.84]	1.04 [0.56–1.95]
GP 5	0.92 [0.60–1.42]	0.93 [0.61–1.42]
GP 6	2.08 [1.07–4.04]	1.99 [1.22–3.23]
GP 7	1.09 [0.71–1.67]	1.11 [0.73–1.69]
GP 8	1.00 [0.54–1.85]	1.12 [0.66–1.90]
GP 9	1.10 [0.43–2.81]	1.71 [0.83–3.55]
GP 10	0.22 [0.12–0.38]	0.22 [0.13–0.38]
GP 11	0.34 [0.20–0.58]	0.35 [0.21–0.59]
GP 12	0.58 [0.34–1.00]	0.59 [0.34–1.00]
GP 13	0.29 [0.17–0.49]	0.30 [0.18–0.51]
GP 14	0.35 [0.21–0.58]	0.38 [0.23–0.62]
GP 15	1 (reference)	1 (reference)
Depression
No depression by BDI, purchased antidepressant in 12 months	2.30 [1.27–4.18]	2.37 [1.35–4.19]
Mild depression by BDI, did not purchase antidepressant in 12 months	1.22 [0.90–1.65]	1.28 [0.97–1.69]
Mild depression by BDI, purchased antidepressant in 12 months	4.97 [1.90–12.99]	4.78 [1.67–13.71]
Moderate depression by BDI, did not purchase antidepressant in 12 months	1.40 [0.94–2.08]	1.52 [1.04–2.23]
Moderate depression by BDI, purchased antidepressant in 12 months	12.23 [2.79–53.66]	8.76 [1.62–47.47]
Severe depression by BDI, did not purchase antidepressant in 12 months	2.16 [1.44–3.25]	2.20 [1.50–3.22]
Severe depression by BDI, purchased antidepressant in 12 months	9.29 [3.46–24.92]	9.62 [3.55–26.08]
No depression by BDI, did not purchase antidepressant in 12 months	1 (reference)	1 (reference)

1. ^aOdds ratio [95% confidence interval]
2. ^bAntihypertensive and/or antidiabetic medicine

Appendix 5

Sociodemographic, lifestyle and clinical characteristics of the patients by depression classifications

	BDI (normal) AD(−)b	BDI (mild) AD(−)b	BDI (moderate) AD(-)b	BDI (severe) AD(−)b	AD(+)b	Missingb	Totalb
Gender
Male	503 (39.27%) [36.58–42.00%]	85 (32.44%) [26.81–38.48%]	49 (36.03%) [27.98–44.70%]	42 (27.81%) [20.84–35.68%]	35 (23.65%) [17.06–31.32%]	16 (32.65%) [19.95–47.54%]	730 (36.01%) [33.92–38.15%]
Female	778 (60.73%) [58.00–63.42%]	177 (67.56%) [61.52–73.19%]	87 (63.97%) [55.30–72.02%]	109 (72.19%) [64.32–79.16%]	113 (76.35%) [68.68–82.94%]	33 (67.35%) [52.46–80.05%]	1297 (63.99%) [61.85–66.08%]
Age
Year (mean ± SD)	61.41 (± 13.07)	59.60 (± 13.18)	60.42 (± 12.61)	56.89 (± 11.27)	58.51 (± 12.41)	56.18 (± 13.34)	60.43 (± 12.96)
Education
Less than primary	117 (9.13%) [7.61–10.85%]	29 (11.07%) [7.54–15.51%]	21 (15.44%) [9.82–22.63%]	38 (25.17%) [18.47–32.87%]	19 (12.84%) [7.91–19.32%]	8 (16.33%) [7.32–29.66%]	232 (11.45%) [10.09–12.91%]
Primary	414 (32.32%) [29.76–34.96%]	79 (30.15%) [24.66–36.10%]	51 (37.50%) [29.35–46.21%]	64 (42.38%) [34.39–50.68%]	55 (37.16%) [29.37–45.48%]	18 (36.73%) [23.42–51.71%]	681 (33.60%) [31.54–35.70%]
Vocational	297 (23.19%) [20.90–25.60%]	75 (28.63%) [23.23–34.51%]	36 (26.47%) [19.28–34.72%]	26 (17.22%) [11.57–24.20%]	27 (18.24%) [12.38–25.42%]	12 (24.49%) [13.34–38.87%]	473 (23.33%) [21.51–25.24%]
High school	340 (26.54%) [24.14–29.05%]	61 (23.28%) [18.30–28.88%]	22 (16.18%) [10.42–23.46%]	20 (13.25%) [8.28–19.71%]	37 (25.00%) [18.25–32.78%]	9 (18.37%) [8.76–32.02%]	489 (24.12%) [22.28–26.05%]
Tertiary	113 (8.82%) [7.33–10.51%]	18 (6.87%) [4.12–10.64%]	6 (4.41%) [1.64–9.36%]	3 (1.99%) [0.41–5.70%]	10 (6.76%) [3.29–12.07%]	2 (4.08%) [0.50–13.98%]	152 (7.50%) [6.39–8.73%]
Ethnicity
Roma	55 (4.29%) [3.25–5.55%]	17 (6.49%) [3.82–10.19%]	18 (13.24%) [8.04–20.11%]	29 (19.21%) [13.26–26.40%]	11 (7.43%) [3.77–12.91%]	1 (2.04%) [0.05–10.85%]	131 (6.46%) [5.43–7.62%]
Non-Roma	1223 (95.47%) [94.19–96.54%]	245 (93.51%) [89.81–96.18%]	117 (86.03%) [79.05–91.37%]	122 (80.79%) [73.60–86.74%]	137 (92.57%) [87.09–96.23%]	48 (97.96%) [89.15–99.95%]	1892 (93.34%) [92.17–94.39%]
Missing	3 (0.23%) [0.05–0.68%]	0 (0.00%) [0.00–1.40%]	1 (0.74%) [0.02–4.03%]	0 (0.00%) [0.00–2.41%]	0 (0.00%) [0.00–2.46%]	0 (0.00%) [0.00–7.25%]	4 (0.20%) [0.05–0.50%]
Alcohol consumption by AUDIT
Problem drinker	15 (1.17%) [0.66–1.92%]	1 (0.38%) [0.01–2.11%]	3 (2.21%) [0.46–6.31%]	0 (0.00%) [0.00–2.41%]	1 (0.68%) [0.02–3.71%]	1 (2.04%) [0.05–10.85%]	21 (1.04%) [0.64–1.58%]
Non-problem drinker	1263 (98.59%) [97.79–99.17%]	259 (98.85%) [96.69–99.76%]	133 (97.79%) [93.69–99.54%]	151 (100.00%) [97.59–100.00%]	147 (99.32%) [96.29–99.98%]	48 (97.96%) [89.15–99.95%]	2001 (98.72%) [98.13–99.16%]
Missing	3 (0.23%) [0.05–0.68%]	2 (0.76%) [0.09–2.73%]	0 (0.00%) [0.00–2.68%]	0 (0.00%) [0.00–2.41%]	0 (0.00%) [0.00–2.46%]	0 (0.00%) [0.00–7.25%]	5 (0.25%) [0.08–0.57%]
Smoking
Occasional	25 (1.95%) [1.27–2.87%]	6 (2.29%) [0.84–4.92%]	4 (2.94%) [0.81–7.36%]	7 (4.64%) [1.88–9.32%]	2 (1.35%) [0.16–4.80%]	0 (0.00%) [0.00–7.25%]	44 (2.17%) [1.58–2.90%]
Regular	231 (18.03%) [15.96–20.25%]	59 (22.52%) [17.61–28.06%]	40 (29.41%) [21.91–37.83%]	56 (37.09%) [29.37–45.31%]	45 (30.41%) [23.12–38.50%]	12 (24.49%) [13.34–38.87%]	443 (21.85%) [20.07–23.72%]
Former	266 (20.77%) [18.57–23.09%]	51 (19.47%) [14.85–24.79%]	31 (22.79%) [16.04–30.77%]	25 (16.56%) [11.01–23.46%]	26 (17.57%) [11.81–24.67%]	11 (22.45%) [11.77–36.62%]	410 (20.23%) [18.50–22.04%]
Never	653 (50.98%) [48.20–53.75%]	114 (43.51%) [37.42–49.75%]	50 (36.76%) [28.67–45.45%]	45 (29.80%) [22.64–37.78%]	64 (43.24%) [35.13–51.63%]	22 (44.90%) [30.67–59.77%]	948 (46.77%) [44.58–48.97%]
Missing	106 (8.27%) [6.82–9.92%]	32 (12.21%) [8.51–16.80%]	11 (8.09%) [4.11–14.01%]	18 (11.92%) [7.22–18.18%]	11 (7.43%) [3.77–12.91%]	4 (8.16%) [2.27–19.60%]	182 (8.98%) [7.77–10.31%]
BMI
Obese	660 (51.52%) [48.75–54.29%]	121 (46.18%) [40.03–52.42%]	67 (49.26%) [40.59–57.97%]	71 (47.02%) [38.86–55.30%]	73 (49.32%) [41.02–57.66%]	18 (36.73%) [23.42–51.71%]	1010 (49.83%) [47.63–52.03%]
Normal	611 (47.70%) [44.93–50.47%]	136 (51.91%) [45.68–58.10%]	68 (50.00%) [41.31–58.69%]	72 (47.68%) [39.50–55.96%]	72 (48.65%) [40.36–56.99%]	30 (61.22%) [46.24–74.80%]	989 (48.79%) [46.59–50.99%]
Missing	10 (0.78%) [0.37–1.43%]	5 (1.91%) [0.62–4.40%]	1 (0.74%) [0.02–4.03%]	8 (5.30%) [2.31–10.17%]	3 (2.03%) [0.42–5.81%]	1 (2.04%) [0.05–10.85%]	28 (1.38%) [0.92–1.99%]
Central obesity
Central obesity	1181 (92.19%) [90.59–93.60%]	240 (91.60%) [87.56–94.66%]	125 (91.91%) [85.99–95.89%]	142 (94.04%) [88.99–97.24%]	139 (93.92%) [88.77–97.18%]	44 (89.80%) [77.77–96.60%]	1871 (92.30%) [91.06–93.43%]
Normal	97 (7.57%) [6.18–9.16%]	20 (7.63%) [4.72–11.54%]	11 (8.09%) [4.11–14.01%]	9 (5.96%) [2.76–11.01%]	9 (6.08%) [2.82–11.23%]	4 (8.16%) [2.27–19.60%]	150 (7.40%) [6.30–8.63%]
Missing	3 (0.23%) [0.05–0.68%]	2 (0.76%) [0.09–2.73%]	0 (0.00%) [0.00–2.68%]	0 (0.00%) [0.00–2.41%]	0 (0.00%) [0.00–2.46%]	1 (2.04%) [0.05–10.85%]	6 (0.30%) [0.11–0.64%]
Accompanying disease
Chronic kidney disorder	75 (5.85%) [4.63–7.28%]	17 (6.49%) [3.82–10.19%]	10 (7.35%) [3.58–13.11%]	13 (8.61%) [4.66–14.27%]	8 (5.41%) [2.36–10.37%]	2 (4.08%) [0.50–13.98%]	125 (6.17%) [5.16–7.30%]
No accompanying chronic kidney disorder	1206 (94.15%) [92.72–95.37%]	245 (93.51%) [89.81–96.18%]	126 (92.65%) [86.89–96.42%]	138 (91.39%) [85.73–95.34%]	140 (94.59%) [89.63–97.64%]	47 (95.92%) [86.02–99.50%]	1902 (93.83%) [92.70–94.84%]
Osteoporosis	87 (6.79%) [5.48–8.31%]	26 (9.92%) [6.59–14.20%]	6 (4.41%) [1.64–9.36%]	13 (8.61%) [4.66–14.27%]	15 (10.14%) [5.78–16.17%]	6 (12.24%) [4.63–24.77%]	153 (7.55%) [6.44–8.79%]
No accompanying osteoporosis	1194 (93.21%) [91.69–94.52%]	236 (90.08%) [85.80–93.41%]	130 (95.59%) [90.64–98.36%]	138 (91.39%) [85.73–95.34%]	133 (89.86%) [83.83–94.22%]	43 (87.76%) [75.23–95.37%]	1874 (92.45%) [91.21–93.56%]
Loss of visual acuity or hearing	444 (34.66%) [32.05–37.34%]	114 (43.51%) [37.42–49.75%]	46 (33.82%) [25.94–42.43%]	70 (46.36%) [38.22–54.65%]	58 (39.19%) [31.28–47.54%]	11 (22.45%) [11.77–36.62%]	743 (36.66%) [34.55–38.80%]
No accompanying loss of visual acuity or hearing	837 (65.34%) [62.66–67.95%]	148 (56.49%) [50.25–62.58%]	90 (66.18%) [57.57–74.06%]	81 (53.64%) [45.35–61.78%]	90 (60.81%) [52.46–68.72%]	38 (77.55%) [63.38–88.23%]	1284 (63.34%) [61.20–65.45%]
Chronic musculoskeletal disorders	399 (31.15%) [28.62–33.76%]	114 (43.51%) [37.42–49.75%]	57 (41.91%) [33.51–50.67%]	71 (47.02%) [38.86–55.30%]	63 (42.57%) [34.49–50.95%]	20 (40.82%) [27.00–55.79%]	724 (35.72%) [33.63–37.85%]
No accompanying chronic musculoskeletal disorders	882 (68.85%) [66.24–71.38%]	148 (56.49%) [50.25–62.58%]	79 (58.09%) [49.33–66.49%]	80 (52.98%) [44.70–61.14%]	85 (57.43%) [49.05–65.51%]	29 (59.18%) [44.21–73.00%]	1303 (64.28%) [62.15–66.37%]
Compliance
Purchased medicinea at least four times a year	1023 (79.86%) [77.56–82.02%]	204 (77.86%) [72.34–82.74%]	103 (75.74%) [67.64–82.67%]	122 (80.79%) [73.60–86.74%]	121 (81.76%) [74.58–87.62%]	39 (79.59%) [65.66–89.76%]	1612 (79.53%) [77.70–81.26%]
Purchased medicinea less than four times a year	258 (20.14%) [17.98–22.44%]	58 (22.14%) [17.26–27.66%]	33 (24.26%) [17.33–32.36%]	29 (19.21%) [13.26–26.40%]	27 (18.24%) [12.38–25.42%]	10 (20.41%) [10.24–34.34%]	415 (20.47%) [18.74–22.30%]
Total	1281 (63.20%) [61.05–65.30%]	262 (12.93%) [11.49–14.46%]	136 (6.71%) [5.66–7.89%]	151 (7.45%) [6.34–8.68%]	148 (7.30%) [6.21–8.52%]	49 (2.42%) [1.79–3.18%]	2027 (100.00%) [99.82–100.00%]

1. AD antidepressant drug purchase, BDI Beck Depression Inventory, SD standard deviation
2. ^aAntihypertensive and/or antidiabetic medicine
3. ^bNumber of patients and prevalence (%) [95% confidence interval]