School of Public Health, Taipei Medical University, Taipei, Taiwan.
Psychiatry Res. 2010 Jun 30;178(1):160-5. doi: 10.1016/j.psychres.2008.07.023. Epub 2010 May 8.
This study investigated 6-year follow-up mortality rates and cause of death for persons younger than 45 years old with a history of hospitalisation for major psychiatric disorders after the introduction of the National Health Insurance (NHI). Linkage data combining death certificates with Taiwan NHI research claims data were used. The study cohort was comprised all patients under the age of 45 years, who had been hospitalised for major psychiatric disorders in 1998. Patients aged <45 years undergoing an appendectomy were selected as a control group. Cox proportional hazard regressions were performed to compute the adjusted 6-year hazard ratios. For patients with schizophrenia, major depression, or bipolar disorder, the adjusted risks of dying during the follow-up period were significantly 4.614, 3.707 and 3.866, respectively, times higher than that for appendectomy patients. The adjusted hazard ratios of non-natural dying during the follow-up period were significantly 16.316, 14.626 and 8.481 times for female patients with schizophrenia, major depression, and bipolar disorder, respectively, as high as for female appendectomy patients. The continuing excess mortality among psychiatric patients, from both natural and unnatural causes, still remains even after implementation of a NHI.
本研究调查了在全民健康保险（NHI）实施后，因主要精神疾病住院的 45 岁以下人群 6 年随访死亡率和死亡原因。使用了结合死亡证明和台湾 NHI 研究索赔数据的链接数据。研究队列由所有在 1998 年因主要精神疾病住院的 45 岁以下患者组成。选择年龄<45 岁接受阑尾切除术的患者作为对照组。采用 Cox 比例风险回归计算调整后的 6 年风险比。对于精神分裂症、重度抑郁症或双相情感障碍患者，在随访期间死亡的调整风险分别是阑尾切除术患者的 4.614、3.707 和 3.866 倍。在随访期间，非自然死亡的调整风险对于女性精神分裂症、重度抑郁症和双相情感障碍患者分别是女性阑尾切除术患者的 16.316、14.626 和 8.481 倍，对于女性精神分裂症患者而言是非自然死亡的风险极高。即使在实施 NHI 后，精神疾病患者仍存在持续的超额死亡率，无论是自然原因还是非自然原因。
