Department of Community Psychiatry, Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, Kaohsiung, Taiwan.
J Psychiatr Res. 2013 Apr;47(4):460-6. doi: 10.1016/j.jpsychires.2012.12.007. Epub 2013 Jan 12.
This study sought to estimate the incidence, all-cause mortality and relative risks for patients with schizophrenia after a pneumonia diagnosis.
The population was identified from the Taiwanese National Health Insurance Research Database (NHIRD) in 1999 and included 59,021 patients with schizophrenia and 236,084 age- and sex-matched control participants without schizophrenia. These participants were randomly selected from the 23,981,020-participant NHIRD, which contain 96% of the entire population. Using the 2000-2008 NIHRD, the incidence and nine-year pneumonia-free survival rate of pneumonia (ICD-9-CM codes 486 and 507.0-507.8) were calculated.
Over nine years, 6055 (10.26%) patients with schizophrenia and 7844 (3.32%) controls had pneumonia. The pneumonia incidence density was 11.4/1000 person-years among the patients with schizophrenia, who experienced a 3.09-fold increased risk of developing pneumonia. After adjusting for other covariates, the patients with schizophrenia still experienced a 1.77-fold increased risk of developing pneumonia. Although, without adjustment, fewer schizophrenia patients than controls died after having pneumonia (2121 [35.12%] vs. 3497 [44.62%]), after adjusting for other variables, the mortality hazard ratio for patients with schizophrenia was 1.39.
During a nine-year follow-up, the likelihood of developing pneumonia and all-cause mortality among patients with schizophrenia was higher than that of the non-schizophrenia group as was the mortality rate. Interestingly, the psychiatric proportion of days covered (PDC) was positively associated with pneumonia (OR: 2.51) but negatively associated with death (HR: 0.72). These findings imply the importance of iatrogenic factors and psychotropic drugs (including their benefits and side effects) and highlight the directions for future studies.
本研究旨在评估肺炎诊断后精神分裂症患者的发病率、全因死亡率和相对风险。
该人群来自于 1999 年的台湾全民健康保险研究数据库（NHIRD），包括 59021 例精神分裂症患者和 236084 例年龄和性别匹配的无精神分裂症对照参与者。这些参与者是从包含 23981020 名参与者的 NHIRD 中随机选择的，该数据库包含了 96%的总人口。利用 2000-2008 年 NHIRD，计算了肺炎（ICD-9-CM 代码 486 和 507.0-507.8）的发病率和九年无肺炎生存率。
在九年中，6055 例（10.26%）精神分裂症患者和 7844 例（3.32%）对照者发生了肺炎。精神分裂症患者的肺炎发病率密度为 11.4/1000人年，发生肺炎的风险增加了 3.09 倍。调整其他协变量后，精神分裂症患者发生肺炎的风险仍增加了 1.77 倍。尽管未经调整，发生肺炎后精神分裂症患者的死亡率低于对照组（2121[35.12%]例比 3497[44.62%]例），但调整其他变量后，精神分裂症患者的死亡率危险比为 1.39。
在九年的随访中，精神分裂症患者发生肺炎和全因死亡率的可能性高于非精神分裂症组，死亡率也是如此。有趣的是，精神科药物覆盖天数（PDC）与肺炎呈正相关（OR：2.51），与死亡呈负相关（HR：0.72）。这些发现表明了医源性因素和精神药物（包括它们的益处和副作用）的重要性，并突出了未来研究的方向。
