Research Objectives: Chronic obstructive pulmonary disease (COPD) is a major cause of disability and death worldwide. The prevalence of depression and anxiety in COPD patients is generally higher than those reported in other chronic illnesses, and these mental diseases significantly affect the health expenditures and the course of the diseases on elderly COPD patients. The COPD patients with co-morbid depression, anxiety or other chronic diseases are more impaired and have 50% to 100% higher medical costs than those without depression and anxiety. COPD affects approximately 1.8 million people in Taiwan every year, however, little studies have examined the impacts of mental diseases on elderly COPD patients. This study aims to investigate the depression and anxiety status on COPD patients¡¦ medical care utilizations and health outcomes. Study Design: This study analyzed the nationally representative research database from National Health Insurance program between 2002 and 2006 in Taiwan, by exploring outpatient visits, hospitalizations, and medical expenditures of COPD and its associated co-morbidities. The data analyses were carried out by Chi-square test, multiple linear regression and multivariate logistic regression. Population Studied: Patient aged over 65 with primary diagnosis of COPD and co-morbidity diseases based on ICD-9-CM in Taiwan. To investigate the complications in COPD patients, four diseases such as diabetes, hypertension, heart failure and ischemic heart disease were included in the analyses. Principle Findings: Among the 5,735 COPD patients (59.81%, male), most of them were aged over 80 (28.67%) , and lived in urban areas (62.28%) in northern Taiwan (43.71%). The results indicated that those who were suffered from depression or anxiety increased medical utilization and costs. Multiple linear regression model showed that age, and hospital level significantly affect the expenditures for medicine of COPD patients with depression or anxiety (p¡Õ0.001). Multivariate logistic regression model presented that number of complications significantly affect the probability of hospitalization among the COPD patients with mental diseases (p¡Õ0.001). Conclusions¡G COPD symptoms were usually getting worsen over time and depression or anxiety affect the COPD patients significantly, though the mental diseases are usually under-estimated. The study results demonstrated that COPD patients suffered from depression and anxiety increased the risks on longer length of stay, higher medical expenditures and more complications. WHO predicts that COPD will become the third leading cause of death worldwide by 2030. Since mental diseases may worsen elderly COPD patients¡¦ health outcomes, physicians are advised to pay more attention to these types of patients. With on time and appropriate treatments, thus may help to improve quality of care and reduce medical expenditures for these patients.

Abstract Research Objectives¡GThe chronic diseases of the elderly not only influence their life quality but also become a great burden of the society on the health care costs. International studies focused on the utilization of medical care resources for diabetes mellitus patients of comorbidity, such as cardiovascular disease¡Bcerebrovascular disease¡Brenal disease and hypertensive. However, systemic analyses on the medical care utilization of the diabetes patients with comorbidity have not been well-studied in Taiwan. The purposes of the study are to quantitatively analyze the relationships between the number of comorbidity and the utilization of medical are resources, and to further discuss the interference on the utilization of medical care resources among individual diseases of the comorbidity. The research questions are: What is the effect of comorbidity on the type and volume of the utilization of medical care resources? Which comorbidity pattern has the highest effect? Methods¡GBased on the databases established by the Bureau of National Health Insurance during the period of 2005 to 2006, the diabetes patients with aged 65 or older have been analyzed. The data analyses have been carried out by Chi-square test, T-test, Pearson¡¦s correlation, and Multiple Regression and Logistic regression. Result¡GOur results showed that the clinic-visiting frequencies of outpatients with a comorbidity score of 0, 1, 2 and 3 are 52, 69 , 70 and 86 times, respectively, and their expenses are NT dollars 50,505, 97,347, 83,006 and 146,954, respectively. The hospital admission frequency of inpatients with a comorbidity score of 0, 1, 2 and 3 are 2 , 3, 3 and 5 times, respectively; the length of stay are 24, 29, 27 and 60 days, respectively; and the inpatient expense are NT dollars 118,079, 174,727, 147,639 and 271,725 respectively. In addition, the logistic regression model showed that ORs for the probability of hospitalization for the patients with comorbidity scores of 1, 2 and 3 were higher than those with the comorbidity score of 0¡]OR=1.689, OR=1.597, OR=3.319¡^respectively. Conclusion¡GA clear gradient was observed between the number of comorbidities and the increased health care utilizations. Moreover, comorbidity among diabetes patients is associated with considerable consequences of health care and related costs. In addition, current single-disease approach of diabetes care should be extended to the integrated care modules, which must be generic and include comorbidity disease in order to meet the complex health care demands of diabetes patients in the future.