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ABSTRACT
Objectives: The relationship between employee wage status and mental health care utilization has not been characterized in large-scale analyses. This study assessed health care utilization and cost patterns for mental health diagnoses according to wage category among employees with health insurance.
Study Design: This was an observational, retrospective cohort study for the year 2017 among 2,386,844 adult full-time employees (254,851 with mental health disorders; subgroup of 125,247 with depression) enrolled in self-insured plans in the IBM Watson Health MarketScan research database.
Methods: Participants were stratified into annual wage categories: $34,000 or less; more than $34,000 to $45,000; more than $45,000 to $69,000; more than $69,000 to $103,000; and more than $103,000. Health care utilization and costs were analyzed via regression analyses.
Results: Prevalence of diagnosed mental health disorders was 10.7% (9.3% in the lowest-wage category); prevalence of depression was 5.2% (4.2% in the lowest-wage category). Severity of mental health, and specifically depression episodes, was greater in lower-wage categories. All-cause utilization of health care services was higher in patients with mental health diagnoses vs the total population. Among patients with mental health diagnoses, specifically depression, utilization was highest in the lowest- vs highest-wage category for hospital admissions, emergency department visits, and prescription drug supply (all P .0001). All-cause health care costs were higher in the lowest- vs highest-wage category among patients with mental health diagnoses ($11,183 vs $10,519; P .0001), specifically depression ($12,206 vs $11,272; P $34,000-$45,000) for more detailed analysis.
Study End Points
End points are reported for the total population, patients with mental health diagnoses, and the subgroup of patients with depression. Demographic information was captured as described in the eAppendix Methods.
Prevalence of diagnosed mental health disorders was calculated as the proportion of participants meeting IBM Watson Health's Medical Episode Grouper criteria for a mental health condition as a percentage of the total study population. Severity of a mental health episode was analyzed based on the highest disease severity (from 1.0 to 4.0) recorded for that episode (eAppendix Methods).
Mental health–specific utilization and costs were calculated for services with a principal diagnosis of mental health according to ICD-10 codes. Health care utilization was analyzed for the following outcomes: hospital admissions, length of hospital stays, outpatient services, ED visits, and supply of a...