Objective. This analysis focuses on the effect of depression on the cost of hospitalization of stroke patients. Methods. Data on 17,010 stroke patients (primary diagnosis) were extracted from 2008 Tennessee Hospital Discharge Data System. Three groups of patients were compared: (1) stroke only ( , ), (2) stroke + depression ( , ), and (3) stroke + other mental health diagnoses ( , ). Results. Of all adult patients, 4.3% were diagnosed with stroke. Stroke was more prevalent among blacks than whites (4.5% versus 4.2%, ) and among males than females (5.1% versus 3.7%, ). Nearly one-quarter of stroke patients (23.3%) were diagnosed with depression/anxiety. Hospital stroke cost was higher among depressed stroke patients ( ) compared to stroke only ( ) patients ($77,864 versus $47,790, ), and among , cost was higher for black males compared to white depressed males ($97,196 versus $88,115, ). Similar racial trends in cost emerged among females. Conclusion. Depression in stroke patients is associated with increased hospitalization costs. Higher stroke cost among blacks may reflect the impact of comorbidities and the delay in care of serious health conditions. Attention to early detection of depression in stroke patients might reduce inpatient healthcare costs. 1. Background Between 20% and 60% of stroke patients are diagnosed with depression/anxiety , and these are often newly diagnosed in stroke patients both during hospitalization and up to 3 years after discharge [1–20]. Depression is associated with longer institutionalization and poorer rehabilitation outcomes [21, 22]. Further, depression is more often diagnosed for females and white stroke patients [23, 24], and it is correlated with higher rates of suicidal ideation and stroke mortality [25–27]. Depression increases the risk of stroke  as well as increased healthcare costs [29–34]. As these and other stroke related factors are evaluated, understanding their impact on healthcare cost is necessary for better management, improved therapeutic outcomes, and reduced healthcare cost. 2. Depression and Healthcare Cost Several studies have reported the effect of depression/anxiety on healthcare costs. For example, while female Medicare patients had a higher prevalence of depression and higher use of outpatient services, inpatient hospital costs for male patients were 47% higher compared to females ($15,060 versus $10,240, ) . In another study, the medical cost of depressed patients was 54% higher compared to nondepressed patients . While higher cost among stroke patients is associated with
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