Prevalence and Impact of Depression Among Patients Hospitalized With COPD From 2016 to 2023: A Population‐Based Study in Spain

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Purpose Depression is a frequent comorbidity in individuals with chronic obstructive pulmonary disease (COPD) and is associated with adverse clinical outcomes, including an increased risk of exacerbations and death. This study aimed to describe national trends in the prevalence of depression among COPD hospitalizations in Spain, from 2016 to 2023, to assess sex‐related differences, to evaluate its impact on hospital outcomes, and to determine how the COVID‐19 pandemic modified these associations. Patients and Methods We carried out a population‐based cohort study using data from the Spanish National Hospital Discharge Database (RAE‐CMBD). All admissions of patients aged 40 years or older with a diagnosis of COPD were included. Depression was identified through International Classification of Diseases, Tenth Revision (ICD‐10) codes. We analyzed temporal changes and sex‐stratified patterns and factors independently associated with in‐hospital mortality (IHM). Results During the study period, 2,545,151 hospitalizations with COPD were recorded nationwide, of which 106,337 (4.17%) included a diagnosis of depression. The prevalence rose progressively, remaining consistently higher in women. Female patients exhibited greater frequencies of anxiety, obesity, and personality disorders, whereas men showed higher rates of alcohol (17.9% vs. 6.1%; p < 0.001) and tobacco use (58.5% vs. 43.4%; p < 0.001) and a greater proportion of suicide attempts (0.11% vs. 0.06%; p < 0.001). Men were also older (74.1 vs. 73.3 years; p < 0.001) and had higher Charlson Comorbidity Index (CCI) values (1.31 vs. 1.01; p < 0.001). ICU admissions (5.0% vs. 4.6%; p < 0.001) and IHM (7.8% vs. 5.6%; p < 0.001) were more common in men. In multivariable models, older age and greater comorbidity burden were the strongest predictors of IHM in both sexes. COVID‐19 infection and dementia increased the odds of death, whereas anxiety and obesity were inversely associated with mortality. Conclusion Between 2016 and 2023, depression among COPD hospitalizations in Spain increased steadily, with clear sex‐based differences in prevalence, clinical profile, and hospital outcomes. The results emphasize the need to integrate mental health screening and management into routine COPD care.

Rising depression prevalence in COPD hospitalizations, especially in women, warrants vigilance; leaves open whether screening improves outcomes.