Department of Community Psychiatry, Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, 130, Kai-Syuan 2nd Rd, Lingya District, Kaohsiung City, Taiwan.
Soc Psychiatry Psychiatr Epidemiol. 2014 Jan;49(1):89-96. doi: 10.1007/s00127-013-0716-9. Epub 2013 Jun 2.
This study investigates the relationship between individual and neighborhood socioeconomic status (SES) and mortality among patients with schizophrenia.
A study population was identified from the National Health Insurance Research Database (NHIRD) prior to the end of 1999 that included 60,402 patients with schizophrenia. Each patient was tracked until death or to the end of 2009. Individual SESs were defined by enrollee category. Neighborhood SES was defined by enrollee category (as a proxy for occupation) and education, which were classified according to the conventions of Hollingshead. Neighborhoods were also grouped into advantaged and disadvantaged areas. The Cox proportional hazards model was used to compare the death-free survival rate between the different SES groups after adjusting for possible confounding factors and risk factors.
During the 10-year follow-up period, the mortality rates among high, moderate, and low individual SES groups were 12.22, 14.75, and 18.48%, respectively (P < 0.001). Schizophrenia patients with low individual SESs in disadvantaged neighborhoods had a risk of death that was 18-22% higher than that of those with high individual SES in advantaged neighborhoods. The analysis of the combined effect of individual SES and neighborhood SES revealed that the death rates were highest among those with low individual SES and low neighborhood SES (P < 0.001).
Schizophrenia patients with low individual SES in disadvantaged neighborhoods have the highest risk of mortality despite a universal health-care system. Public health strategies and welfare policies must continue to focus on this vulnerable group.
本研究旨在探讨个体和社区社会经济地位（SES）与精神分裂症患者死亡率之间的关系。
本研究从 1999 年底前的国家健康保险研究数据库（NHIRD）中确定了一个研究人群，其中包括 60402 例精神分裂症患者。每位患者都被跟踪随访，直至死亡或 2009 年底。个体 SES 通过参保类别来定义。社区 SES 通过参保类别（作为职业的替代指标）和教育来定义，教育则按照 Hollingshead 的分类标准进行分类。社区还分为优势和劣势地区。使用 Cox 比例风险模型，在调整可能的混杂因素和风险因素后，比较不同 SES 组之间的无死亡生存率。
在 10 年的随访期间，高、中、低个体 SES 组的死亡率分别为 12.22%、14.75%和 18.48%（P < 0.001）。处于劣势社区且 SES 较低的精神分裂症患者的死亡风险比处于优势社区且 SES 较高的患者高 18-22%。个体 SES 和社区 SES 的综合效应分析表明，SES 较低且社区 SES 较低的患者死亡率最高（P < 0.001）。
尽管实行了全民医保制度，但 SES 较低且处于劣势社区的精神分裂症患者的死亡率仍然最高。公共卫生策略和福利政策必须继续关注这一弱势群体。
