Woodhead Charlotte, Ashworth Mark, Schofield Peter, Henderson Max
Department of Psychological Medicine, Institute of Psychiatry, King's College London, London, UK.
BMC Fam Pract. 2014 Jun 11;15:117. doi: 10.1186/1471-2296-15-117.
Serious mental illness (SMI) is associated with elevated mortality compared to the general population; the majority of this excess is attributable to co-occurring common physical health conditions. There may be variation within the SMI group in the distribution of physical co/multi-morbidity. This study aims to a) compare the pattern of physical co- and multi-morbidity between patients with and without SMI within a South London primary care population; and, b) to explore socio-demographic and health risk factors associated with excess physical morbidity among the SMI group.
Data were obtained from Lambeth DataNet, a database of electronic patient records derived from general practices in the London borough of Lambeth. The pattern of 12 co-morbid common physical conditions was compared by SMI status. Multivariate ordinal and logistic regression analyses were conducted to assess the strength of association between each condition and SMI status; adjustments were made for potentially confounding socio-demographic characteristics and for potentially mediating health risk factors.
While SMI patients were more frequently recorded with all 12 physical conditions than non-SMI patients, the pattern of co-/multi-morbidity was similar between the two groups. Adjustment for socio-demographic characteristics - in particular age and, to a lesser extent ethnicity, considerably reduced effect sizes and accounted for some of the associations, though several conditions remained strongly associated with SMI status. Evidence for mediation by health risk factors, in particular BMI, was supported.
SMI patients are at an elevated risk of a range of physical health conditions than non-SMI patients but they do not appear to experience a different pattern of co-/multimorbidity among those conditions considered. Socio-demographic differences between the two groups account for some of the excess in morbidity and known health risk factors are likely to mediate the association. Further work to examine a wider range of conditions and health risk factors would help determine the extent of excess mortality attributable to these factors.
与普通人群相比，严重精神疾病（SMI）患者的死亡率更高；这种额外的死亡率大部分可归因于同时存在的常见身体健康状况。在SMI患者群体中，身体合并症/多重疾病的分布可能存在差异。本研究旨在：a）比较伦敦南部初级保健人群中患有和未患有SMI的患者之间身体合并症和多重疾病的模式；b）探讨与SMI患者群体中身体发病率过高相关的社会人口学和健康风险因素。
数据来自兰贝斯数据网，这是一个从伦敦兰贝斯区的全科医疗中获取的电子患者记录数据库。根据SMI状态比较了12种合并常见身体状况的模式。进行了多变量有序和逻辑回归分析，以评估每种状况与SMI状态之间的关联强度；对潜在的混杂社会人口学特征和潜在的中介健康风险因素进行了调整。
虽然SMI患者比非SMI患者更频繁地被记录患有所有12种身体状况，但两组之间的合并症/多重疾病模式相似。对社会人口学特征进行调整——特别是年龄，以及在较小程度上的种族，显著降低了效应大小，并解释了部分关联，尽管仍有几种状况与SMI状态密切相关。健康风险因素（特别是体重指数）的中介作用得到了证据支持。
与非SMI患者相比，SMI患者患一系列身体健康状况的风险更高，但在考虑的这些状况中，他们似乎没有经历不同的合并症/多重疾病模式。两组之间的社会人口学差异解释了部分发病率过高的情况，已知的健康风险因素可能介导了这种关联。进一步研究更广泛的状况和健康风险因素将有助于确定这些因素导致的额外死亡率的程度。
