Alcohol Epidemiologic Data System, CSR, Incorporated, Arlington, VA 22201-3085, USA.
Compr Psychiatry. 2011 Sep-Oct;52(5):453-64. doi: 10.1016/j.comppsych.2010.10.005. Epub 2010 Dec 13.
The aim of this study was to quantify the effect of comorbid alcohol and drug use disorders on premature death, as reflected by the manner of death (suicide and other unnatural death versus natural death) and the age at death, among decedents with unipolar and bipolar disorders.
This study is based on the US Multiple Cause of Death public-use data files for 1999 to 2006. Secondary data analysis was conducted comparing decedents with unipolar/bipolar disorders and decedents with all other causes of death, based on the death records of 19,052,468 decedents in the Multiple Cause of Death data files who died at 15 years and older. Poisson regression models were used to derive prevalence ratios to assess the effect of comorbid substance use disorders (SUD) on the risks for being an unnatural death among mood disorder deaths. Multiple-cause life table analysis and mean age at death were used to quantify the effect of comorbid SUDs on premature mortality among mood disorder deaths.
Prevalence of comorbid SUDs was higher among unipolar and bipolar disorder deaths than that among all other deaths. Among unipolar and bipolar disorder deaths, comorbid SUDs were associated with elevated risks for suicide and other unnatural death in both men and women (prevalence ratios ranging 1.49-9.46, P < .05). They also were associated with reductions in mean ages at death (ranging 11.7-33.8 years, P < .05). In general, these effects were much stronger for drug use disorders than for alcohol use disorders. Both SUDs had stronger effects on suicide among women, whereas their effects on other unnatural deaths were stronger among men.
This study is among the first to provide population mortality-based evidence to further establish comorbid SUD as one of the key risk factors for premature death among individuals with unipolar or bipolar disorders in the United States. Clinicians need to be aware of the potentially lethal risk associated with these comorbid conditions.
本研究旨在量化同时患有酒精和药物使用障碍对单相和双相障碍患者的早逝率的影响，具体表现为死亡方式（自杀和其他非自然死亡与自然死亡）和死亡年龄。
本研究基于美国 1999 年至 2006 年的死因多原因公共使用数据文件。通过对死因数据文件中 19052468 名 15 岁及以上死亡者的死亡记录进行二次数据分析，比较单相/双相障碍患者和所有其他死因患者。使用泊松回归模型计算患病率比，以评估共病物质使用障碍对心境障碍死亡中发生非自然死亡风险的影响。多死因寿命表分析和平均死亡年龄用于量化共病物质使用障碍对心境障碍死亡中过早死亡的影响。
单相和双相障碍患者的共病物质使用障碍患病率高于所有其他死因患者。在单相和双相障碍患者中，共病物质使用障碍与男女自杀和其他非自然死亡风险增加相关（患病率比为 1.49-9.46，P<0.05）。它们还与平均死亡年龄降低相关（范围为 11.7-33.8 岁，P<0.05）。一般来说，药物使用障碍的这些影响比酒精使用障碍强得多。两种物质使用障碍对女性自杀的影响更强，而对男性其他非自然死亡的影响更强。
本研究是首次提供基于人群死亡率的证据，进一步确立共病物质使用障碍是美国单相或双相障碍患者过早死亡的关键风险因素之一。临床医生需要意识到这些共病的潜在致命风险。
