Pain is the main influence on health care use for older adults with osteoarthritis (OA), and although no synergistic effects were found between pain, depression, and insomnia in this patient population, the combined effects of these symptoms on health care use did significantly increase with increasing severity of insomnia and depression, according to a study published in Arthritis Care & Research.
To assess the independent and combined effect of OA pain with concurrent depression and insomnia on health care use in older adults, the current study used survey data from Group Health Cooperative patients (n=2976). Outcomes were measured using the Graded Chronic Pain Scale, the Patient Health Questionnaire-8, and the Insomnia Severity Index, along with health care use data in the categories of office visits, outpatient and inpatient costs, length of stay, and hip or knee replacement, which were extracted from electronic healthcare records for the 3 years following surveys. Logistic, negative binomial, and generalized linear models were used to assess health care use predictors.
In addition to moderate to severe OA pain, 29% of patients presented with subclinical depression, and 34% with subclinical insomnia. The largest independent effect on all categories of health care use was pain, followed by depression, which had a moderate effect on increased office visits, length of stay, and outpatient and inpatient costs. Insomnia had only mild effects on decreased length of stay. No synergistic effects were found between the 3 symptoms and health care use, but the combined effect of pain and insomnia and pain and depression on all categories of health care use was significant, and this effect grew greatly with increased severity of depression and insomnia, except in the category of hip or knee replacement.
Study investigators conclude that pain has a substantial independent effect on health care use. Additionally, the fact that the effects of concurrent pain, depression, and insomnia were additive and the increase on different categories of health care use “increased greatly with increasing insomnia and depression severity after controlling for pain… indicates the important role that concurrent symptomatic conditions may play in increasing use of health care services.”
Liu M, McCurry SM, Belza B, et al. Effects of osteoarthritis pain, and concurrent insomnia and depression on health care use in a primary care population of older adults [published online August 1, 2018]. Arthritis Care Res (Hoboken). doi: 10.1002/acr.23695