Roerecke Michael, Rehm Jürgen
Centre for Addiction and Mental Health, Toronto, Canada, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada and Institut für Klinische Psychologie und Psychotherapie, Technische Universität Dresden, Dresden, GermanyCentre for Addiction and Mental Health, Toronto, Canada, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada and Institut für Klinische Psychologie und Psychotherapie, Technische Universität Dresden, Dresden, Germany
Centre for Addiction and Mental Health, Toronto, Canada, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada and Institut für Klinische Psychologie und Psychotherapie, Technische Universität Dresden, Dresden, GermanyCentre for Addiction and Mental Health, Toronto, Canada, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada and Institut für Klinische Psychologie und Psychotherapie, Technische Universität Dresden, Dresden, GermanyCentre for Addiction and Mental Health, Toronto, Canada, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada and Institut für Klinische Psychologie und Psychotherapie, Technische Universität Dresden, Dresden, Germany.
Int J Epidemiol. 2014 Jun;43(3):906-19. doi: 10.1093/ije/dyu018. Epub 2014 Feb 10.
Alcohol use disorders (AUD) are highly disabling. Recent studies reported much higher relative risks for all-cause mortality in AUD patients compared with earlier studies. Systematic evidence regarding cause-specific mortality among AUD patients has been unavailable to date.
Studies were identified through MEDLINE, EMBASE and Web of Science up to August 2012. Following MOOSE guidelines, prospective and historical cohort studies assessing cause-specific mortality risk from AUD patients at baseline compared with the general population were selected. Data on several study characteristics, including AUD assessment, follow-up period, setting, location and cause-specific mortality risk compared with the general population were abstracted. Random-effect meta-analyses were conducted.
Overall, 17 observational studies with 6420 observed deaths among 28 087 AUD patients were included. Pooled standardized mortality ratios (SMRs) after 10 years of follow-up among men were 14.8 (95% confidence interval: 8.7-24.9) for liver cirrhosis, 18.0 (11.2-30.3) for mental disorders, 6.6 (5.0-8.8) for death by injury and around 2 for cancer and cardiovascular diseases. SMRs were substantially higher in women, with fewer studies available. For many outcomes the risk has been increasing substantially over time.
Cause-specific mortality among AUD patients was high in all major categories compared with the general population. There has been a lack of recent research, and future studies should focus on the influence of comorbidities on excess mortality risk among AUD patients. Efforts to reduce these risks should be a priority, given that successful treatment reduces mortality risk substantially for a relatively common psychiatric disease.
酒精使用障碍（AUD）具有高度致残性。近期研究报告称，与早期研究相比，AUD患者全因死亡率的相对风险要高得多。迄今为止，尚无关于AUD患者特定病因死亡率的系统性证据。
通过检索截至2012年8月的MEDLINE、EMBASE和科学网来识别研究。遵循MOOSE指南，选择前瞻性和历史性队列研究，评估基线时AUD患者与普通人群相比的特定病因死亡风险。提取了包括AUD评估、随访期、研究背景、地点以及与普通人群相比的特定病因死亡风险等多项研究特征的数据。进行随机效应荟萃分析。
总体而言，纳入了17项观察性研究，共28087名AUD患者，其中观察到6420例死亡。男性随访10年后，肝硬化的合并标准化死亡率（SMR）为14.8（95%置信区间：8.7 - 24.9），精神障碍为18.0（11.2 - 30.3），损伤致死为6.6（5.0 - 8.8），癌症和心血管疾病约为2。女性的SMR显著更高，但可用研究较少。随着时间推移，许多结局的风险大幅增加。
与普通人群相比，AUD患者在所有主要类别中的特定病因死亡率都很高。近期研究不足，未来研究应关注合并症对AUD患者额外死亡风险的影响。鉴于成功治疗可大幅降低一种相对常见精神疾病的死亡风险，降低这些风险的努力应成为优先事项。
