Manderbacka Kristiina, Arffman Martti, Sund Reijo, Haukka Jari, Keskimäki Ilmo, Wahlbeck Kristian
National Institute for Health and Welfare, Helsinki, Finland.
BMJ Open. 2012 Apr 5;2(2):e000831. doi: 10.1136/bmjopen-2012-000831. Print 2012.
Equity in physical health of patients with severe mental disorders is a major public health concern. The aim of this cohort study was to examine equity in access to coronary care among persons with a history of severe mental disorder in 1998-2009.
Nationwide register linkage cohort study.
Hospital care in the Finnish healthcare system.
The study population consisted of all residents in Finland aged 40 years or older. All hospital discharges in 1998-2009 with a diagnosis of coronary heart disease or severe mental disorder were obtained from the Care Register.
Data on deaths, hospitalisations and coronary revascularisations were linked to the data set using unique personal identifiers.
Patients with severe mental disorders had increased likelihood of hospital care due to coronary heart disease (RR between 1.22, 95% CI 1.18 to 1.25 and 1.93, 1.84 to 2.03 in different age groups) and in 40-49-year-olds also increased likelihood of revascularisation (1.26, 1.16 to 1.38) compared with persons without mental disorders. Access to revascularisation was poorer among older persons with severe mental disorders in relation to need suggested by increased coronary mortality. In spite of excess coronary mortality (ranging from 0.95, 0.89 to 1.01 to 3.16, 2.82 to 3.54), worst off were people with a history of psychosis, who did not have increased use of hospital care and had lower likelihood of receiving revascularisations (ranging from 0.44, 0.37 to 0.51 to 0.74, 0.59 to 0.93) compared with persons without mental disorders.
Selective mechanisms seem to be at work in access to care and revascularisations among people with severe mental disorders. Healthcare professionals need to be aware of the need for targeted measures to address challenges in provision of somatic care among people with severe mental health problems, especially among people with psychoses and old people.
严重精神障碍患者的身体健康公平性是一个重大的公共卫生问题。这项队列研究的目的是调查1998年至2009年间有严重精神障碍病史的人群在获得冠心病护理方面的公平性。
全国登记链接队列研究。
芬兰医疗保健系统中的医院护理。
研究人群包括芬兰所有40岁及以上的居民。1998年至2009年所有诊断为冠心病或严重精神障碍的医院出院病例均来自护理登记册。
使用唯一的个人标识符将死亡、住院和冠状动脉血运重建的数据与数据集相关联。
与没有精神障碍的人相比，严重精神障碍患者因冠心病接受医院护理的可能性增加（不同年龄组的相对风险在1.22至1.93之间，95%置信区间为1.18至1.25和1.84至2.03），在40至49岁的人群中，血运重建的可能性也增加（1.26，1.16至1.38）。与冠状动脉死亡率增加所表明的需求相比，老年严重精神障碍患者获得血运重建的情况较差。尽管冠状动脉死亡率过高（范围从0.95至3.16），但情况最糟糕的是有精神病病史的人，与没有精神障碍的人相比，他们没有增加医院护理的使用，接受血运重建的可能性较低（范围从0.44至0.74）。
在严重精神障碍患者获得护理和血运重建方面，似乎存在选择性机制在起作用。医疗保健专业人员需要意识到有必要采取针对性措施，以应对为严重心理健康问题患者，尤其是精神病患者和老年人提供躯体护理方面的挑战。
