This study evaluated the epidemiological relationship between diabetes and incident depression, as well as antidepressant medication utilization among indigent care patients diagnosed with diabetes. Medical data for 2,886 subjects receiving care in a public indigent care provider network were utilized for this study. Diagnoses of diabetes, depression, and other comorbid medical conditions were identified from the electronic medical record. Prescription claims data from the clinic pharmacy network were used to evaluate medication-taking behaviors. Clinical laboratory data were extracted, as available, from the electronic clinic records. After controlling for the influence of age, gender, race/ethnicity, marital status classification, and Charlson score, a diagnosis of diabetes was associated with a 42 percent reduction in odds of new-onset depression (p = 0.021). In the a priori analysis of factors associated with new-onset depression among diabetic patients, none of the risk factors evaluated were associated with incident depression at a statistically significant level. Post-hoc exploratory analyses revealed that female gender and White non-Hispanic race/ethnicity were associated with increased odds of a prevalent diagnosis of depression among diabetic patients. Patients with diabetes were more likely to be prescribed selective serotonin reuptake inhibitors (SSRIs) as their initial antidepressant medication compared to non-SSRIs. Diagnosis of diabetes was not associated with antidepressant switch, discontinuation, or 6-month antidepressant adherence; however, diagnosis of diabetes was associated with a higher level of 12-month antidepressant adherence (p = 0.024). Diagnosis of diabetes was also associated with a higher level of 3-month antidepressant persistence (p = 0.004), but not 12-month persistence. There were no statistically significant relationships observed between initial class of antidepressant medication prescribed and any of the medication-taking behaviors evaluated. For subjects with available data (n = 106), glycemic control was evaluated in terms of hemoglobin A1c. Increased antidepressant medication adherence was associated with higher hemoglobin A1c values during follow-up. Results suggest that prevalent diabetes is associated with a reduced risk of diagnosis of new-onset depression in indigent care patients. Further research is necessary to evaluate the effect that chronic comorbid medical conditions such as diabetes may have on antidepressant medication-taking behaviors, and the relationship between antidepressant exposure and glycemic control. / text

<p dir="ltr">Although guideline-recommended long-term use of adjuvant hormone therapy (HT) is highly effective in improving breast cancer outcomes, empirical HT use is suboptimal and not well-understood. The overall objective of this study was to assess associations between patient characteristics, physician characteristics, hospital characteristics, and community characteristics and use of hormone therapy operationalized as initiation, adherence, and persistence. A retrospective analysis of the Surveillance, Epidemiology, and End Results (SEER) registry linked with Medicare claims was conducted. The full study sample included older women diagnosed with hormone receptor-positive stage I-III breast cancer from 2010 through 2014. Initiation was defined as filling at least one prescription for HT. Adherence was defined as having proportion of days covered (PDC) of 0.80 or more in the first year. Persistence was defined as having no HT discontinuation, i.e., a break of at least 90 continuous days at any point during the study period. Length of persistence was calculated as time from therapy initiation to discontinuation. All analyses were conducted using SAS 9.4. An a priori alpha level of 0.05 was used to determine significance for all the analyses. ICC values were assessed to test for clustering at physician, hospital, and zip code level. A marginal model with clustering at zip code level was used to assess associations between study predictor variables and outcome variables. Logistic Regression models were constructed to assess associations between HT initiation and adherence and study predictors while Cox Proportional Hazards models were constructed to assess associations between HT persistence and study predictor variables. Final models were restricted to the patients who had non-missing provider data (15,014 patients for initiation, 9,949 patients for adherence/persistence). 65.46[64.93, 66.00] % of all candidates initiated HT, first year adherence rate was 76.77[76.17, 77.36] % and overall persistence rate was 64.24[63.55, 64.92]. Initiation of hormone therapy was associated with age, race, marital status, dual eligibility, tumor stage and HER2 status, physician specialty, hospital ownership, and zip code median education level; adherence to hormone therapy was associated with type of hormone therapy, medication switches, HER2 status of tumor, physician specialty, teaching hospital status and zip code median education level; and persistence with hormone therapy was associated with type of hormone therapy, medication switches, physician specialty, hospital physician count and urban/rural residence.</p>