Mental Health Disorders and Risk of Hospitalizations and Emergency Department Utilization Among Individuals With Congenital Heart Defects Público
Chen, Joy (Spring 2022)
Abstract
Background: Congenital heart defects (CHD) occur in approximately 1% of live U.S. births and are comprised of a wide range of diagnoses ranging in severity and need for intervention. Mental health disorders (MHD) contribute significantly to the global burden of disease. Approximately one-third of adults with CHD in the U.S. are reported to have a mood or anxiety disorder. Concurrent MHD with CHD has been linked to poorer physical health, lower quality of life, and increased hospitalizations.
Methods: This is a retrospective cohort of patients aged 14 to 55 with CHD who were seen at Emory Healthcare and Children’s Healthcare of Atlanta between January 1, 2010 and December 31, 2019. Bivariate analysis and multivariate logistic regression models were created to evaluate the impacts of MHD and CHD on hospitalizations and emergency department (ED) visits. Demographic factors such as age, sex, race and ethnicity, insurance, and rurality were also included.
Results: Females with a MHD had higher odds for hospitalizations than males regardless of whether CHD was categorized using four anatomic groups (OR 4.63 95% CI [4.01-5.34] vs. 3.21 [2.72-3.79]) or collapsed into severe and non-severe (4.64 [4.02-5.35] vs. 3.22 [2.73-3.79]) or conotruncal and non-conotruncal (4.99 [3.78-6.62] vs. 3.39 [2.44-4.72]). Urban patients with a MHD had higher odds for an ED visit when categorized by 4 anatomic groups (2.78, [2.33-3.32]) or by severe and non-severe (2.85 [2.40-3.37]) while rural patients did not. Finally, among conotruncal patients, Hispanic patients with a MHD had higher odds for an ED visit (8.39 [2.14-37.56]) than non-Hispanic white (2.28 [1.43-3.63]) and non-Hispanic black patients (2.83 [1.69-4.68]).
Conclusions: In conclusion, MHD appears to have significant impacts on hospitalizations and ED visits. Various demographic and social factors such as sex, rurality, and race, also appear to have a role in this relationship.
Table of Contents
CHAPTER 1: BACKGROUND 1
Congenital Heart Defects (CHD) 1
Defect Classifications and Population-Based Surveillance Prevalence 1
Challenges in Care 3
Mental Health Disorders 4
Prevalence of Common Mental Health Disorders 4
Demographic and Socioeconomic Factors Impacting Mental Health 5
Age of Onset 7
Congenital Heart Defects and Mental Health Disorders 7
Depression and Anxiety 7
Post-Traumatic Stress Disorder (PTSD) 10
Schizophrenia and other Psychotic Disorders 12
CHAPTER II: METHODS 14
Hypothesis 14
Specific Aims 14
Study Design and Population 14
Data Management and IRB 15
Inclusion and Exclusion Criteria 15
Outcome Variables 16
Exposure Variables 16
Any Mental Health Disorder 16
Depressive Disorder 17
Anxiety Disorder 17
Bipolar Disorder 17
Post-Traumatic Stress Disorder (PTSD) 18
Personality Disorder 18
Neurodevelopmental and Behavior Disorders 18
Psychotic Disorder and Schizophrenia 18
Covariates 19
CHD Severity 19
Conotruncal Defects 20
Age 20
Sex 20
Race and Ethnicity 20
Insurance Type 21
Rurality 21
CHAPTER III: RESULTS 23
Descriptive Statistics 23
Logistic Regression Models 27
CHAPTER IV: DISCUSSION 32
Limitations 36
CHAPTER V: PUBLIC HEALTH IMPLICATIONS AND FUTURE DIRECTIONS 38
REFERENCES 41
FIGURES 63
Figure 1: Analytic Dataset Construction 63
TABLES 64
Table 1. Descriptive Characteristics of Patients with Congenital Heart Defects (CHD) who have received care at Emory Healthcare and/or Children’s Healthcare of Atlanta, 2010-2019 64
Table 2. Bivariate Analyses: Distribution of Covariate Percentages on Hospitalizations and Emergency Department (ED) Visits for Patients with Congenital Heart Defects (CHD) and Co-occurring Mental Health Disorders (MHD) who have received care at Emory Healthcare and/or Children’s Healthcare of Atlanta 65
Table 3. Unadjusted Analyses: Risk of Hospitalizations and Emergency Department (ED) Visits with Covariates for Patients with Congenital Heart Defects (CHD) and Co-occurring Mental Health Disorders (MHD) who have received care at Emory Healthcare and/or Children’s Healthcare of Atlanta, 66
Table 4a. Adjusted Analyses: Risk of Hospitalizations for Select Covariates for Patients with Congenital Heart Defects (CHD) and Co-Occurring Mental Health Disorders (MHD) who have received care at Emory Healthcare and/or Children’s Healthcare of Atlanta 67
Table 4b. Adjusted Analyses: Risk of Emergency Department (ED) Visits for Select Covariates for Patients with Congenital Heart Defects (CHD) and Co-Occurring Mental Health Disorders (MHD) who have received care at Emory Healthcare and/or Children’s Healthcare of Atlanta 67
Table 5a. Adjusted Analyses: Risk of Hospitalizations for Select Covariates for Patients with Severe vs. Non-Severe Congenital Heart Defects (CHD) and Co-Occurring Mental Health Disorders (MHD) who have received care at Emory Healthcare and/or Children’s Healthcare of Atlanta 68
Table 5b. Adjusted Analyses: Risk of Emergency Department (ED) Visits for Select Covariates for Patients with Severe vs. Non-Severe Congenital Heart Defects (CHD) and Co-Occurring Mental Health Disorders (MHD) who have received care at Emory Healthcare and/or Children’s Healthcare of Atlanta 68
Table 6a. Adjusted Analyses: Risk of Hospitalizations for Select Covariates for Patients with Conotruncal vs. Non-Conotruncal Congenital Heart Defects (CHD) and Co-Occurring Mental Health Disorders (MHD) who have received care at Emory Healthcare and/or Children’s Healthcare of Atlanta 69
Table 6b. Adjusted Analyses: Risk of Emergency Department (ED) Visits for Select Covariates for Patients with Conotruncal vs. Non-Conotruncal Congenital Heart Defects (CHD) and Co-Occurring Mental Health Disorders (MHD) who have received care at Emory Healthcare and/or Children’s Healthcare of Atlanta 69
APPENDICES 70
APPENDIX A: CHD Severity Group Assignment 70
APPENDIX B: ICD-9-CM and ICD-10-CM Codes for Seven Mental Health Disorders 74
APPENDIX C: ICD-9-CM and ICD-10-CM Codes for Conotruncal Defects 80
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