B40-11 Examining the Role of Depressive Symptoms in Healthcare Utilization for Asthma

Rationale

Major depressive disorder is common among individuals with asthma and has been associated with with poorer symptom control and increased healthcare use. It is unclear whether depressive symptoms independently drive asthma-related healthcare utilization or whether observed associations are explained by other factors. Using harmonized data from multiple asthma cohorts, we evaluated whether depressive symptoms were associated with asthma-related healthcare utilization in the preceding year and whether this relationship differed across demographic and clinical subgroups.

Methods

We conducted a cross-sectional analysis using the American Lung Association database, combining data from three questionnaires: ABBS (n = 102), TRIM (n = 38), and TAPE (n = 601). Depressive symptoms were categorized using validated instruments: PHQ-9 (≥10 vs < 10) for ABBS and TRIM, CES-D (≥16 vs < 15) for TAPE. The primary outcome was asthma-related healthcare utilization in the preceding year, defined as a binary variable. For ABBS/TRIM, utilization was any urgent doctor visit for breathing problems within the past year versus never or > 1 year ago; TAPE assessed any asthma-related doctor, emergency department, or hospital visit in the past year (yes/no). Logistic regression estimated crude and adjusted odds ratios (ORs) for the association between depressive symptoms and healthcare utilization. Adjusted models included BMI, sex, and race. Effect modification was assessed using interaction terms for depressive symptoms with BMI (<30 vs ≥ 30), sex, and race (White vs non-White).

Results

In crude analyses, participants with depressive symptoms had higher odds of urgent asthma-related visits in the past year (OR 1.28, 95% CI 0.92-1.77; p = 0.146), though this association was not statistically significant. After adjustment for BMI, sex, and race, the association attenuated (adjusted OR 1.18, 95% CI 0.85-1.66; p = 0.324), indicating mild confounding. BMI was a significant independent predictor of healthcare utilization (OR 1.03 per unit increase; p = 0.0036). White race was associated with lower odds compared with non-White participants (OR 0.59; p = 0.0010). Sex was not significantly associated with healthcare utilization. Subgroup analyses showed no effect modification by BMI (p = 0.523), sex (p = 0.150), or race (p = 0.563).

Conclusions

Although depressive symptoms were associated with higher odds of urgent asthma-related healthcare use in unadjusted analyses, this finding was not statistically significant, and the relationship was largely explained by BMI and race. Depressive symptoms were not an independent predictor, nor did their effect vary across subgroups. BMI and race were independent predictors of healthcare utilization. These findings suggest that clinical and sociodemographic factors, not depressive symptoms, are the primary drivers of urgent asthma care in this population.

This abstract is funded by: American Lung Associtaion - ALA 1494717