부산대학교 도서관

Introduction: Diseases of despair (DoD) are a major cause of premature mortality in the United States (U.S.) and include substance use and sequela, and suicidality. How despair-related illnesses are associated with atherosclerotic cardiovascular disease (ASCVD) and impact healthcare utilization in those with ASCVD is not established.Methods: International Classification of Diseases-10 codes were used to identify adults in the Highmark Health insurance claims database with ASCVD (composite of myocardial infarction, ischemic stroke, ischemic cardiomyopathy and peripheral vascular disease) from 2017-2021. In patients with ASCVD, baseline characteristics were compared between those with and without DoD. Hazard ratios (HR) and 95% confidence intervals (CIs) were calculated to assess the risk of ASCVD between those with and without DoD over 5-years of follow-up.Results: Among patients analyzed (n=983,513), 67,340 were diagnosed with ASCVD. Among those with ASCVD, 3.1% (2,059) had DoD. Those with DoD that developed ASCVD were younger (<45 years), more likely to smoke, more likely to use psychotherapy services, had more inpatient and outpatient utilization, and had increased total healthcare costs relative to those without DoD that developed ASCVD (Table 1). In addition, those with DoD had an increased risk of ASCVD compared to those without DoD (HR 1.43; 95% CI 1.37-1.50). Covariates adjusted for include frailty, obesity, smoking, gender, age, rurality, and area-level poverty, educational attainment, and social vulnerability.Conclusions: Among adults with ASCVD, those with DoD are younger and have higher healthcare utilization. In addition, DoD is associated with an increased risk of ASCVD. Further research to understand cardiovascular disease prevention in those with DoD could reduce healthcare costs and save lives. Also, there is a need to examine overlapping structural factors that may be contributing to concurrent rises in both ASCVD and DoD in the U.S.