严重精神疾病退伍军人失访后的死因特异性死亡率。
Cause-specific mortality among Veterans with serious mental illness lost to follow-up.
机构信息
VA National Serious Mental Illness Treatment Resource and Evaluation Center and VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA.
出版信息
Gen Hosp Psychiatry. 2012 Nov-Dec;34(6):651-3. doi: 10.1016/j.genhosppsych.2012.05.014. Epub 2012 Jul 12.
OBJECTIVE
Although reduced care engagement has been linked to increased mortality for persons with serious mental illness (SMI), there have been limited investigations into specific mortality causes for this group. This study evaluates the effects of care disengagement on mortality cause and time until death in Veterans with SMI.
METHOD
A total of 3300 Veterans with SMI lost to Veterans Affairs care for more than 1 year were contacted by providers who attempted treatment reengagement. Fisher's Exact Tests evaluated associations between mortality cause and reengagement status, and a Cox proportional hazard model evaluated the association between reengagement and survival.
RESULTS
During the study, 146 (4.6%) patients died. A lack of reengagement was associated with increased noninjury death [odds ratio (OR)=1.64], increased cancer-based mortality (OR=4.76) and an average of 97.4 fewer days of life.
CONCLUSIONS
Care reengagement may support medical care management and reduce preventable medical mortality for Veterans with SMI.
目的
尽管减少医疗保健参与与严重精神疾病（SMI）患者的死亡率增加有关，但针对该人群的具体死亡原因的研究有限。本研究评估了医疗保健脱离对退伍军人 SMI 患者死亡原因和死亡时间的影响。
方法
通过医疗服务提供者联系了超过 1 年未接受退伍军人事务部医疗保健的总共 3300 名 SMI 退伍军人，尝试重新开始治疗。通过 Fisher 精确检验评估了死亡率原因与重新参与状态之间的关联，通过 Cox 比例风险模型评估了重新参与与生存之间的关联。
结果
在研究期间，有 146 名（4.6%）患者死亡。缺乏重新参与与非伤害性死亡的增加相关[优势比（OR）=1.64]，癌症相关死亡率的增加（OR=4.76）以及平均减少了 97.4 天的寿命。
结论
医疗保健重新参与可能支持医疗保健管理，并减少退伍军人 SMI 患者的可预防医疗死亡率。
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