Prevalence of Mental Health Burden Among Men and Women Hospitalized With Critical Limb Ischemia: Insights From the National Inpatient Sample

Kristie M. Harris; Ahmad Arham; Carlos Mena-Hurtado; Matthew M. Burg; Kim Smolderen

doi:10.1016/j.jvs.2021.06.247

Objective Contemporary data suggest that demographics of the critical limb ischemia (CLI) patient population are changing, with hospital admission rates among adults under age 65 surging, accounting for up to 40% of all cases. The individual burden and risk profile of CLI is likely to differ for these younger adults. In other cardiovascular patient populations, including coronary artery disease and heart failure, mental health diagnoses are more frequent in younger individuals, especially women, and thus we examined whether this is also the case for CLI admissions over time. Methods The study cohort was derived using discharge data from the National Inpatient Sample database for years 2011 to 2017. Hospitalizations in patients with CLI were identified, and patients were divided into four groups: men <65 years, women <65 years, men ≥65 years, and women ≥65 years. We used International Classification of Diseases, Ninth Revision, Clinical Modification and International Classification of Diseases, Tenth Revision, Clinical Modification diagnostic codes to identify comorbid mood disorders (major depressive disorder, bipolar disorder) and anxiety disorders (generalized anxiety disorder, phobias). For each year, we calculated the prevalence of these comorbidities overall and separately across the four patient groups. Temporal trends were evaluated using the Cochran-Mantel-Haenszel test. Results From 2011 to 2017, there were 2,642,780 CLI-related hospitalizations across the four patient groups. During this time, the prevalence of comorbid mood disorders in patients hospitalized for CLI overall increased from 12.0% to 15.0% (Ptrend <.001), while the prevalence of comorbid anxiety disorders nearly tripled from 3.8% to 10.0% (Ptrend <.001). The percentage of patients with a comorbid mood and/or anxiety disorder similarly increased from 14.8% to 20.2% (Ptrend <.001), with the greatest increase observed among women <65 years (mood: 20.4%- 24.2%; anxiety: 6.0%-17.1%; mood and/or anxiety: 24.9%-31.9%). Women ≥65 years, and men regardless of age group, also demonstrated an increased prevalence in mental health comorbidities over time, yet at a slower rate (Fig). Conclusions The mental health burden for patients hospitalized with CLI has increased nationwide in recent years, a burden that is primarily concentrated in younger women. The implications of CLI for working-age adults are severe and may contribute to greater disease-related distress, increased risk of complications and disease progression, and lost years of productivity. Assessment of mental health in patients presenting with CLI is needed to determine the effect on disease trajectory and patient health status, and to establish appropriate care pathways to address patients' mental health needs.

Prevalence of Mental Health Burden Among Men and Women Hospitalized With Critical Limb Ischemia: Insights From the National Inpatient Sample

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