Tsay Jen-Huoy, Lee Cheng-Hua, Hsu Yea-Jen, Wang Pen-Jen, Bai Ya-Mei, Chou Yiing-Jenq, Huang Nicole
Department of Social Work, College of Social Science, National Taiwan University, Taipei, Taiwan, R.O.C.
BMC Public Health. 2007 Nov 15;7:331. doi: 10.1186/1471-2458-7-331.
Many studies have been carried out that focus on mental patients' access to care for their mental illness, but very few pay attention on these same patients' access to care for their physical diseases. Acute appendicitis is a common surgical emergency. Our population-based study was to test for any possible association between mental illness and perforated appendicitis. We hypothesized that there are significant disparities in access to timely surgical care between appendicitis patients with and without mental illness, and more specifically, between patients with schizophrenia and those with another major mental illness.
Using the National Health Insurance (NHI) hospital-discharge data, we compared the likelihood of perforated appendix among 97,589 adults aged 15 and over who were hospitalized for acute appendicitis in Taiwan between the years 1997 to 2001. Among all the patients admitted for appendicitis, the outcome measure was the odds of appendiceal rupture vs. appendicitis that did not result in a ruptured appendix.
After adjusting for age, gender, ethnicity, socioeconomic status (SES) and hospital characteristics, the presence of schizophrenia was associated with a 2.83 times higher risk of having a ruptured appendix (odds ratio [OR], 2.83; 95% confidence interval [CI], 2.20-3.64). However, the presence of affective psychoses (OR, 1.15; 95% CI: 0.77-1.73) or other mental disorders (OR, 1.58; 95% CI: 0.89-2.81) was not a significant predictor for a ruptured appendix.
These findings suggest that given the fact that the NHI program reduces financial barriers to care for mentally ill patients, they are still at a disadvantage for obtaining timely treatment for their physical diseases. Of patients with a major mental illness, schizophrenic patients may be the most vulnerable ones for obtaining timely surgical care.
许多研究聚焦于精神病患者获得精神疾病治疗的情况，但很少关注这些患者获得躯体疾病治疗的情况。急性阑尾炎是一种常见的外科急症。我们基于人群的研究旨在检验精神疾病与穿孔性阑尾炎之间是否存在任何可能的关联。我们假设，患有和未患有精神疾病的阑尾炎患者在获得及时手术治疗方面存在显著差异，更具体地说，精神分裂症患者与患有其他主要精神疾病的患者之间存在差异。
利用国民健康保险（NHI）的医院出院数据，我们比较了1997年至2001年期间在台湾因急性阑尾炎住院的97589名15岁及以上成年人中发生穿孔性阑尾炎的可能性。在所有因阑尾炎入院的患者中，结局指标是阑尾破裂与未导致阑尾破裂的阑尾炎的比值比。
在调整年龄、性别、种族、社会经济地位（SES）和医院特征后，精神分裂症的存在与阑尾破裂风险高2.83倍相关（比值比[OR]，2.83；95%置信区间[CI]，2.20 - 3.64）。然而，情感性精神病（OR，1.15；95% CI：0.77 - 1.73）或其他精神障碍（OR，1.58；95% CI：0.89 - 2.81）并非阑尾破裂的显著预测因素。
这些发现表明，尽管国民健康保险计划减少了精神病患者获得治疗的经济障碍，但他们在获得躯体疾病及时治疗方面仍处于劣势。在患有主要精神疾病的患者中，精神分裂症患者可能是最难以获得及时手术治疗的群体。
