Comparison of depression risk and depression-related ambulatory care utilization in sarcopenia patients with and without Chinese herbal medicine

Table 1 Demographic data and selected comorbidities of cases and controls, n (%)

Variables	Number (%)	Cases (n = 1610)	Controls (n = 3220)	P value
Age (years)				0.82
≤ 50	2129 (44.1)	706 (43.9)	1423 (44.2)
> 50	2701 (55.9)	904 (56.1)	1797 (55.8)
mean ± SD	52.6 ± 15.5	52.5 ± 15.5	52.7 ± 15.4	0.60
Gender				0.97
Male	1630 (33.7)	544 (33.8)	1086 (33.7)
Female	3200 (66.3)	1066 (66.2)	2134 (66.3)
Monthly income				0.79
25th percentile	2227 (46.1)	736 (45.7)	1491 (46.3)
50th percentile	2417 (50.0)	808 (50.2)	1609 (50.0)
75th percentile	186 (3.9)	66 (4.1)	120 (3.7)
Residential typologies				0.06
Urban area	2594 (53.7)	867 (53.8)	1727 (53.6)
Suburban area	768 (15.9)	230 (14.3)	538 (16.7)
Rural area	1468 (30.4)	513 (31.9)	955 (29.7)
CCI	4.57 (9.6)	4.95 (9.6)	4.38 (9.6)	0.06

CCI: Charlson-Deyo Comorbidity Index.

Table 2 Chinese herbal medicines use and risk of depression by the conditional logistic regression, n (%)

CHMs exposure	Subjects		Crude OR (95%CI)	Adjusted OR (95%CI)
	Cases (n = 1610)	Controls (n = 3230)
Non-CHMs users	993 (61.7)	1737 (53.9)	1	1
CHMs users	617 (38.3)	1483 (46.1)	0.72 (0.64-0.82)	0.71 (0.62-0.80)
Level 1 (< 1 year)	561 (34.8)	1237 (38.4)	0.79 (0.69-0.90)	0.77 (0.68-0.88)
Level 2 (1-3 years)	39 (2.4)	167 (5.2)	0.41 (0.28-0.58)	0.40 (0.28-0.57)
Level 3 (3 years or more)	17 (1.1)	79 (2.5)	0.37 (0.22-0.64)	0.35 (0.21-0.60)

Adjusted for potential confounders that included age, gender, residential area, monthly income and Charlson-Deyo Comorbidity Index. CHMs: Chinese herbal medicines; OR: Odds ratio; CI: Confidence intervals.

Table 3 Age- and gender-specific risk of depression in sarcopenia patients with regard to exposure of Chinese herbal medicines use, n (%)

Variables	Depression cases	Crude OR (95%CI)	Adjusted OR (95%CI)
Female
Non-CHMs users	611 (57.3)	1	1
CHMs users	455 (42.7)	0.72 (0.61-0.80)	0.60 (0.60-0.81)1
Male
Non-CHMs users	382 (70.2)	1	1
CHMs users	162 (29.8)	0.74 (0.59-0.91)	0.75 (0.60-0.93)1
Age > 50 years
Non-CHMs users	587 (64.9)	1	1
CHMs users	317 (35.9)	0.83 (0.71-0.98)	0.82 (0.70-0.98)2
Age ≤ 50 years
Non-CHMs users	411 (58.2)	1	1
CHMs users	295 (41.8)	0.59 (0.49-0.70)	0.58 (0.48-0.97)2

¹Model adjusted for age, residential area, monthly income, and Charlson-Deyo Comorbidity Index.

²Model adjusted for gender, residential area, monthly income, and Charlson-Deyo Comorbidity Index.

CHMs: Chinese herbal medicines; OR: Odds ratio; CI: Confidence interval.

Table 4 Comparison of frequency and costs of following depression-related ambulatory care between two groups from the index date to the end of follow-up

	CHMs group	Non-CHMs group	P value
1 year after depression
Total visits of ambulatory care	2010	2730	< 0.001
Mean costs for per ambulatory care	72.44	102.93	0.001
1-3 years after depression
Total visits of ambulatory care	2899	5819	< 0.001
Mean costs for per ambulatory care	71.85	129.15	< 0.001
3 years or more after depression
Total visits of ambulatory care	2687	7813	< 0.001
Mean costs for per ambulatory care	60.99	157.62	< 0.001

Costs were transformed into United States dollars according to the exchange rate of 2013. CHMs: Chinese herbal medicines.

Table 5 The ingredient herbs contained in the most-used single-herb and multi-herb products among participants

Chinese herbal product	Ingredients	Functional classification	Daily dose (g)	Frequency
Single-herb products
Yan-Hu-Suo	Corydalis yanhusuo	Used to treat Qi stagnation, blood stasis, chest pain, abdominal pain, amenorrhea, dysmenorrhea, and postpartum stasis	8.3	3970
Bei-Mu	Fritillariae Thunbergii Bulbus	Eliminates phlegm by cooling, moistens, lungs to arrest cough, and removes stasis, to reduce swelling	8.9	3236
Jie-Geng	Radix Platycodi	Support respiratory health and benefit the throat; contain anti-inflammatory, antibacterial, expectorant and immune boosting properties	7.4	3065
Da-Huang	Rheum officinale	Addresses constipation and other, inflammatory issues in the colon, liver, gallbladder, stomach, and reproductive organs	6.7	3048
Ge-Gen	Kudzu Root	Treats infectious respiratory diseases	8.1	2943
Huang-Qin	Scutellaria baicalensis	Used as an adjuvant therapy for inflammation, diabetes, hypertension, and different kinds of cancers and virus-related diseases	9.8	2785
Hai-Piao-Xiao	Endoconcha Sepiae (Os Sepiae seu Sepiellae)	Controls acidity, harmonizes the stomach, and alleviates pain	7.0	2512
Ye-Jiao-Teng	Caulis Polygoni Multiflori	Nourishes the heart and liver blood and expels wind in the collaterals to stop itch and treat skin disorders	8.4	2007
San-Qi	Roots of Panax notoginseng	Used for cardiovascular diseases	6.2	1302
Chuan-Niu-Xi	Radix Cyathulae	Activates blood, eliminates stasis, strengthens tendons and bones, promotes urination, treats dysuria	8.4	1014
Multi-herb products
Jia-Wei-Xiao-Yao-San	Bupleurum root, Angelica sinensis root, White Peony root, White Atractylodes Rhizome, Poria, Licorice root, Moutan bark, Gardenia fruit, Mint Herb, Ginger	To treat functional dyspepsia	8.5	5084
Shu-Jing-Huo-Xie-Tang	Tang-kuei root, White peony root, Corydalis root, Chin-chiu, Cnidium root, Raw rehmannia root, Peach kernel, Hoelen fungus, Atractylodes root, Citrus peel, Notopterygium root, Fragrant angelica, Scabrous gentiana root, Fangfeng root, Achyranthes root, Ginger root, Chinese licorice root	Clears heat, cools the blood, nourishes yin and generates fluids; breaks up blood stasis and invigorates blood circulation; strongly dries dampness, tonifies the spleen, induces sweating and expels wind-dampness; promotes urination and leaches out dampness	7.9	4143
Ge-Gen-Tang	Kudzu root Pueraria lobata, Cassia twig Cinnamomum cassia, Ginger fresh rhizome Zingiber officinale, Chinese peony root without bark Paeonia lactiflora, Chinese licorice root and rhizome Glycyrrhiza uralensis, Jujube fruit Ziziphus jujuba, Notopterygium root and rhizome Notopterygium incisum, Pubescent angelica root Angelica pubescens, Sichuan lovage rhizome Ligusticum chuanxiong, Bupleurum root Bupleurum chinense	Chinese herbs for upper respiratory tract infection, cervical myositis, tendinitis of the shoulder, lymphadenitis and cerebrovascular disease	10.2	2943
Shao-Yao-Gan-Cao-Tang	Paeonia Lactiflora, Glycyrrhiza Uralensis	Treat spleen and liver blood deficiency	7.4	2898
Chuan-Xiong-Cha-Tiao-San	Radix Chuanxiong, Herba Schizonepetae, Radix Saposhnikoviae, Rhizoma et Radix Notopterygii, Radix et Rhizoma Glycyrrhizae, Radix Angelicae Dahuricae, Herba Menthae, Radix et Rhizoma Asari	Used to treat headaches caused by externally-contracted wind pathogens	8.9	2499
Du-Huo-Ji-Sheng-Tang	Herba Taxilli, Radix Rehmanniae, Poria, Radix Angelicae Pubescentis, Radix Gentianae Macrophyllae, Radix Saposhnikoviae, Cortex Eucommiae, Radix Achyranthis Bidentatae, Radix Angelicae Sinensis, Radix Alba Paeoniae, Radix Ginseng, Rhizoma Chuanxiong, Cortex Cinnamomi, Radix Glycyrrhizae, Pericarpium Zanthoxyli	Reduces inflammation severity and encourages the lymphatic function	6.0	2408
Ping-Wei-San	Atractylodes lancea rhizome, Magnolia officinalis bark, Citrus reticulata peel, Glycyrrhiza uralensis root, Zingiber officinale rhizome, Ziziphus jujuba fruit	Reduces inflammation severity and encourages the lymphatic function	6.5	2173
Ban-Xia-Xie-Xin-Tang	Pinellia ternate, Makino, Panax ginseng, Zingiber officinale Roscoe, Coptis chinensis Franch, Scutellaria baicalensis Georgi, Ziziphus jujuba Mill	Treating metabolic diseases, such as nonalcohol fatty liver disease, diabetes mellitus, and obesity	10.2	2169
Tian-Wang-Bu-Xin-Dan	Ginseng Radix et Rhizoma, Poria, Scrophulariae Radix, Salviae Miltiorrhizae Radix et Rhizoma, Platycodonis Radix, Polygalae Radix, Angelicae Sinensis Radix, Schisandrae Chinensis Fructus, Ophiopogonis Radix, Asparagi Radix, Platycladi Semen, Ziziphi Spinosae Semen, Rehmanniae Radix	Enriches yin and clears heat, nourishes blood and calms the mind	7.6	1638
Xin-Yi-Qing-Fei-Tang	Gypsum, Ophiopogon Tuber, Scutellaria root (root of Scutellaria baicalensis), Gardenia fruit, Anemarrhena rhizome, Lilium Bulb, Magnolia flower, Loquat leaf, and Cimicifuga rhizome	Used to treat sinusitis associated with purulent nasal discharge and reddish nasal mucosa	4.8	1481